Background: Preoperative personalized programs (prehabilitation) are effective in reducing postoperative complications in high-risk patients undergoing major abdominal surgery. However, its effects on healthcare costs are still unknown.


Goal of Study: To determine the cost-effectiveness of prehabilitation program versus conventional care for high-risk patients undergoing elective major abdominal surgery.


Materials and Methods: This study involved data arising from a previously published randomized controlled trial which demonstrated the efficacy of prehabilitation versus standard care in reducing postoperative complications in high-risk undergoing major abdominal surgery (Barberan-Garcia A, et al. Ann Surg 2017). The costs of the prehabilitation program and hospital resources related to surgery were also evaluated. Prehabilitation program costs included: i) a cardiopulmonary exercise testing; ii) the physiotherapist fees; and, iii) a pedometer device. Surgery costs included: i) direct costs (pharmacy and transfusions); and, ii) costs for hospital length of stay (days of initial hospitalization plus days during 30- day readmissions) by diagnosis-related group. Data were obtained for each patient. Information on costs was provided by the hospital finance department. Uncertainty was expressed using bootstrapped estimates (1,000 repetitions).


Results: One-hundred and twenty-five patients (63 control and 62 intervention), out of the 144 participating in the study, were finally included in the intention-to-treat analysis. Prehabilitation program cost was EUR 389 per patient. The average hospital costs per patient in the prehabilitation group were EUR 4,340 and in the control group were EUR 7,643 (p=0.134). The impact of the prehabilitation in comparison with standard care represented a mean saving of:

• 3,659€ per patient (95% IC EUR -36 to 8,459 €) taking in account the whole sample and the 30-day readmission costs.

• 757€ per patient (95% IC EUR -880 to 2,583 €) taking in account the reduced sample (removing the outliers) and the readmission costs.


Conclusion: Prehabilitation showed positive mean savings compared to standard care for high-risk patients in major abdominal surgery but results were not statistically significant. A larger sample size may have resulted in a statistically significant result.

Supported by ESA Grant support 2016 and ISCIII PI13/00425

04 / Cost-effectiveness analysis of a prehabilitation program in high-risk patients undergoing elective major abdominal surgery