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Prehabilitation and Postoperative Outcomes in Major Surgery: A Retrospective Cohort Study Using MarketScan Claims
Meher Angez1, Zayed Rashid2, Odysseas P Chatzipanagiotou1
1Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
World Journal of Surgery
|June 10, 2026
Summary
Prehabilitation, a program of exercise and support before surgery, was linked to fewer cardiac complications but increased costs. These benefits were most notable in patients undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Surgical Outcomes Research
- Patient Recovery Optimization
- Health Services Research
Background:
- Prehabilitation, encompassing exercise, nutrition, and behavioral support, aims to enhance patient physiological reserve before surgery.
- Limited large-scale, real-world data exists evaluating prehabilitation across diverse surgical procedures.
Purpose of the Study:
- To assess the real-world impact of prehabilitation on postoperative complications, readmissions, and costs in patients undergoing major surgeries.
- To identify specific surgical procedures where prehabilitation demonstrates the most significant benefits.
Main Methods:
- Retrospective cohort study using IBM MarketScan claims data from 2010-2020.
- Identified adult patients undergoing coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, pneumonectomy, pancreatectomy, and colectomy.
- Defined prehabilitation as claims for physical therapy, nutrition, psychological, and smoking cessation services within 30-90 days preoperatively; analyzed outcomes using multivariable logistic regression.
Main Results:
- Of 136,674 patients, 6.6% received prehabilitation.
- Prehabilitation was associated with reduced odds of any major postoperative complication (aOR 0.94) and myocardial infarction (MI) (aOR 0.78).
- Prehabilitation led to higher perioperative costs but showed sustained MI reduction in CABG patients.
Conclusions:
- Prehabilitation is associated with decreased postoperative cardiac events, particularly MI, but incurs higher perioperative costs.
- The most significant positive associations were observed in patients undergoing coronary artery bypass grafting (CABG).
- Further cautious interpretation of subgroup findings is warranted.
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