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Published on: January 8, 2020
Prehabilitation for patients undergoing metabolic/bariatric surgery: a retrospective cohort study using propensity
Yiling Yan1, Shengdi Lu2, Heming Wang3
1Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Importance:
Multimodal prehabilitation improves outcomes in colorectal surgery, but its effectiveness and cost-effectiveness before metabolic and bariatric surgery are unknown.
Objective:
To evaluate the effectiveness and cost-effectiveness of a 6-week multimodal prehabilitation programme compared with standard preintervention education in patients undergoing bariatric surgery.
Design, Setting, And Participants:
Propensity score matched cohort observational study at Shanghai Tenth People's Hospital, China, January 2022 to January 2025. Sixty prehabilitation patients were matched 1:1 to 60 controls from 254 standard care candidates using nearest-neighbour matching on the logit of the propensity score. Follow-up was 12 months.
Interventions:
A 6-week programme of supervised exercise, nutritional counselling, and psychological support vs 2 standard preoperative counselling sessions. All patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy.
Main Outcomes And Measures:
Total weight loss at 12 months. Secondary outcomes included body composition, metabolic parameters, functional capacity, patient-reported outcomes, safety, and healthcare costs.
Results:
Among 120 matched patients (mean [SD] age, 32.6 [5.2] years; 65.8% male; mean body mass index [BMI], 38.2 [3.2] kg/m2), total weight loss at 12 months did not differ between groups (23.7 [5.1] vs 23.4 [2.7] kg; difference, 0.3 kg; 95% CI, -1.3 to 1.8; p = 0.75). At 3 months, prehabilitation showed significantly greater weight loss (adjusted β = 2.85 kg; 95% CI, 1.77 to 3.93; p < 0.001), lower body fat, lower diastolic blood pressure, and higher Short Form-36 (SF-36) mental scores. All differences were attenuated by 6 months. No serious adverse events occurred. Total costs were modestly higher in the prehabilitation group (mean, ¥84 843 vs ¥78 051), a difference attributable almost entirely to the prehabilitation programme itself; because the incremental effect on weight loss at 12 months was not statistically significant, a meaningful incremental cost-effectiveness ratio could not be estimated.
Conclusions And Relevance:
A 6-week multimodal prehabilitation programme accelerated early postoperative weight loss and improved short-term functional outcomes but did not improve total weight loss at 12 months. Because prehabilitation added cost without a demonstrable difference in 12-month weight loss, a cost-effectiveness advantage could not be established. The dominant metabolic effects of bariatric surgery appear to override the incremental gains of preoperative conditioning over time.