Prehabilitation and Postoperative Outcomes in Major Surgery: A Retrospective Cohort Study Using MarketScan Claims Data.

Abstract

Prehabilitation, including preoperative exercise, nutrition optimization, behavioral support, and smoking cessation services, may improve physiological reserve in patients undergoing surgery; however, large administrative and claims-based real-world evaluations across diverse procedure types have remained limited. This retrospective cohort study used IBM MarketScan claims (2010-2020) to identify adults undergoing coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy. Prehabilitation was defined as claims for physical therapy, nutrition counseling, psychological/behavioral counseling, and smoking cessation services within 30-90 days preoperatively. Multivariable logistic regression assessed outcomes, including any major postoperative complication, readmission, and costs, adjusting for baseline patient and hospital factors. Among 136,674 patients, 6.6% (n = 9077) received prehabilitation. The median age was 56 (49-60), and 42.0% (n = 57,035) were female. Patients who received prehabilitation more commonly underwent pneumonectomy (15.8% vs. 11.3%) or AAA repair (4.7% vs. 3.2%) and received care at urban/metropolitan hospitals (86.9% vs. 84.7%) compared with individuals who did not undergo prehabilitation (all p < 0.001). Prehabilitation was associated with lower odds of any index complication (aOR 0.94, 95% CI 0.90-0.99) and lower risk of myocardial infarction (MI) at index hospitalization (aOR 0.78, 95% CI 0.71-0.85), 30 days (aOR 0.79, 95% CI 0.72-0.86), and 90 days (aOR 0.81, 95% CI 0.74-0.89). Moreover, patients who received prehabilitation experienced higher costs, both preoperatively (β 4227, 95% CI 3834-4621) and postoperatively (β 4020, 95% CI 2866-5173). In sub-analyses, the association between prehabilitation and lower odds of MI was maintained among CABG patients (aOR 0.83, 95% CI 0.76-0.90). Prehabilitation was associated with lower postoperative cardiac events but higher perioperative costs; the most favorable associations were observed among CABG patients, although these subgroup findings should be interpreted cautiously.