LAUSR

OBJECTIVE To determine if a preoperative multidisciplinary prehabilitation program (Surgical Prehabilitation and Readiness [SPAR]) reduces postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients. BACKGROUND The preoperative period is an important target for interventions (e.g. SPAR) that can improve postoperative outcomes for older patients with comorbidities. METHODS Surgical patients enrolled in a prehabilitation program targeting physical activity, pulmonary function, nutrition, and mindfulness were compared to historical control patients from 1 institution's American College of Surgeons (ACS) NSQIP database. SPAR patients were propensity score matched 1:3 to pre-SPAR NSQIP patients and their outcomes compared. The ACS NSQIP Surgical Risk Calculator was used to compare observed to expected ratios (O/E) for postoperative outcomes. RESULTS 246 patients were enrolled in SPAR. A six-month compliance audit revealed that overall patient adherence to the SPAR program was 89%. At the time of analysis, 118 SPAR patients underwent surgery with 30 days of follow up. Compared to pre-SPAR NSQIP patients (n=4028), SPAR patients were significantly older with worse functional status and more comorbidities. Compared to propensity score-matched pre-SPAR NSQIP patients, SPAR patients had significantly decreased 30-day mortality (0% vs 4.1%, p=0.036) and decreased need for discharge to post-acute care facilities (6.5% vs 15.9%, p=0.014). Similarly, SPAR patients exhibited decreased observed 30-day mortality (O/E: 0.41) and need for discharge to a facility (O/E: 0.56) compared to their expected outcomes using the ACS NSQIP Surgical Risk Calculator. CONCLUSION The SPAR program is safe, feasible, and may reduce postoperative mortality and the need for discharge to post-acute care facilities in high-risk surgical patients.