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Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial.
Br J Anaesth 2019; 123(4):450-456BJ

Abstract

BACKGROUND

Prehabilitation may reduce postoperative complications, but sustainability of its health benefits and impact on costs needs further evaluation. Our aim was to assess the midterm clinical impact and costs from a hospital perspective of an endurance-exercise-training-based prehabilitation programme in high-risk patients undergoing major digestive surgery.

METHODS

A cost-consequence analysis was performed using secondary data from a randomised, blinded clinical trial. The main outcomes assessed were (i) 30-day hospital readmissions, (ii) endurance time (ET) during an exercise testing, and (iii) physical activity by the Yale Physical Activity Survey (YPAS). Healthcare use for the cost analysis included costs of the prehabilitation programme, hospitalisation, and 30-day emergency room visits and hospital readmissions.

RESULTS

We included 125 patients in an intention-to-treat analysis. Prehabilitation showed a protective effect for 30-day hospital readmissions (relative risk: 6.4; 95% confidence interval [CI]: 1.4-30.0). Prehabilitation-induced enhancement of ET and YPAS remained statistically significant between groups at the end of the 3 and 6 month follow-up periods, respectively (ΔET 205 [151] s; P=0.048) (ΔYPAS 7 [2]; P=0.016). The mean cost of the programme was €389 per patient and did not increment the total costs of the surgical process (€812; CI: 95% -878 - 2642; P=0.365).

CONCLUSIONS

Prehabilitation may result in health value generation. Moreover, it appears to be a protective intervention for 30-day hospital readmissions, and its effects on aerobic capacity and physical activity may show sustainability at midterm.

CLINICAL TRIAL REGISTRATION

NCT02024776.

Authors+Show Affiliations

Respiratory Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Madrid, Spain. Electronic address: anbarber@clinic.cat.Anaesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.UPF Barcelona School of Management, Spain; Economics and Business Department, Centre for Research in Health and Economics (CRES-UPF), Pompeu Fabra University, Barcelona, Spain.Anaesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.Economics and Business Department, Centre for Research in Health and Economics (CRES-UPF), Pompeu Fabra University, Barcelona, Spain; Economics Department, Metabolic and Digestive Diseases Institute, Spain.Anaesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain; Biomedical Networking Research Centre on Hepatic Diseases (CIBEREHD), Madrid, Spain.UPF Barcelona School of Management, Spain; Economics and Business Department, Centre for Research in Health and Economics (CRES-UPF), Pompeu Fabra University, Barcelona, Spain.Respiratory Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Madrid, Spain.August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain; Anaesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31248644

Citation

Barberan-Garcia, A, et al. "Post-discharge Impact and Cost-consequence Analysis of Prehabilitation in High-risk Patients Undergoing Major Abdominal Surgery: Secondary Results From a Randomised Controlled Trial." British Journal of Anaesthesia, vol. 123, no. 4, 2019, pp. 450-456.
Barberan-Garcia A, Ubre M, Pascual-Argente N, et al. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. Br J Anaesth. 2019;123(4):450-456.
Barberan-Garcia, A., Ubre, M., Pascual-Argente, N., Risco, R., Faner, J., Balust, J., ... Martinez-Palli, G. (2019). Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. British Journal of Anaesthesia, 123(4), pp. 450-456. doi:10.1016/j.bja.2019.05.032.
Barberan-Garcia A, et al. Post-discharge Impact and Cost-consequence Analysis of Prehabilitation in High-risk Patients Undergoing Major Abdominal Surgery: Secondary Results From a Randomised Controlled Trial. Br J Anaesth. 2019;123(4):450-456. PubMed PMID: 31248644.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. AU - Barberan-Garcia,A, AU - Ubre,M, AU - Pascual-Argente,N, AU - Risco,R, AU - Faner,J, AU - Balust,J, AU - Lacy,A M, AU - Puig-Junoy,J, AU - Roca,J, AU - Martinez-Palli,G, Y1 - 2019/06/25/ PY - 2018/12/17/received PY - 2019/04/29/revised PY - 2019/05/16/accepted PY - 2019/6/30/pubmed PY - 2019/9/21/medline PY - 2019/6/29/entrez KW - aerobic capacity KW - cost-consequence analysis KW - exercise therapy KW - hospital readmission KW - postoperative complications KW - prehabilitation KW - preoperative care SP - 450 EP - 456 JF - British journal of anaesthesia JO - Br J Anaesth VL - 123 IS - 4 N2 - BACKGROUND: Prehabilitation may reduce postoperative complications, but sustainability of its health benefits and impact on costs needs further evaluation. Our aim was to assess the midterm clinical impact and costs from a hospital perspective of an endurance-exercise-training-based prehabilitation programme in high-risk patients undergoing major digestive surgery. METHODS: A cost-consequence analysis was performed using secondary data from a randomised, blinded clinical trial. The main outcomes assessed were (i) 30-day hospital readmissions, (ii) endurance time (ET) during an exercise testing, and (iii) physical activity by the Yale Physical Activity Survey (YPAS). Healthcare use for the cost analysis included costs of the prehabilitation programme, hospitalisation, and 30-day emergency room visits and hospital readmissions. RESULTS: We included 125 patients in an intention-to-treat analysis. Prehabilitation showed a protective effect for 30-day hospital readmissions (relative risk: 6.4; 95% confidence interval [CI]: 1.4-30.0). Prehabilitation-induced enhancement of ET and YPAS remained statistically significant between groups at the end of the 3 and 6 month follow-up periods, respectively (ΔET 205 [151] s; P=0.048) (ΔYPAS 7 [2]; P=0.016). The mean cost of the programme was €389 per patient and did not increment the total costs of the surgical process (€812; CI: 95% -878 - 2642; P=0.365). CONCLUSIONS: Prehabilitation may result in health value generation. Moreover, it appears to be a protective intervention for 30-day hospital readmissions, and its effects on aerobic capacity and physical activity may show sustainability at midterm. CLINICAL TRIAL REGISTRATION: NCT02024776. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/31248644/Post_discharge_impact_and_cost_consequence_analysis_of_prehabilitation_in_high_risk_patients_undergoing_major_abdominal_surgery:_secondary_results_from_a_randomised_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(19)30436-2 DB - PRIME DP - Unbound Medicine ER -