Hospital costs associated with multimodal prehabilitation for high-risk major elective surgery candidates

Maggie Chen, Daniel Santa Mina, Darren Au, Keyvan Karkouti, Shabbir Alibhai, Michael Zywiel, Ian Randall 

Prehabilitation aims to improve physical and psychological health before surgery to support recovery and reduce the risk of complications. Given the growing body of evidence supporting the feasibility and benefits of prehabilitation, its implementation is increasingly considered among hospital decision-makers. To inform implementation considerations, this hospital perspective cost-analysis of a nonrandomized controlled trial comparing multimodal prehabilitation to usual care (UC) at a large urban academic hospital in Toronto, Ontario, reported the financial implications of prehabilitation implementation in a hospital setting. The prehabilitation program included exercise, nutrition, psychological, and smoking cessation delivered by a dedicated team of clinicians. Patient-level surgical admission and prehabilitation costs were calculated using bottom-up cost estimation methodologies. Percentage difference in total hospital costs was calculated to explore cost-impact. We included 63 participants, 45 (71%) who received prehabilitation and 18 (29%) who received UC. While mean prehabilitation duration was 61 days (SD 55) and cost $413 (SD $285) per patient, surgical admission costs were $32,724.56 (SD$26,674.03) for prehabilitation participants and $43,491.61 (SD $37,341.85) for UC participants. Total costs appeared 24% lower among prehabilitation participants, but this was not statistically significant (99% CI -0.42 to 0.58). Although our findings warrant cautious interpretation given limitations including the small sample, nonrandomized study design, and short time horizon, we found it was feasible to utilize bottom-up methodology to explore cost-impact from a hospital perspective. Further research is necessary to clarify the apparent differences in costs, precisely estimate cost-impact, and continue refining approaches to cost analyses to support the evolving field of prehabilitation.