Multimodal Prehabilitation in Heart Transplant Recipients Improves Short-Term Post-Transplant Outcomes without Increasing Costs

Abstract

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.

How much does it cost to be fit for operation? The economics of prehabilitation

“…This review specifically addresses recent evidence related to the economics and the cost effectiveness of surgical prehabilitation. The programs reported either a reduction in healthcare related costs [10,12,14,15] or no impact on them [9 ▪ ,13,16 ▪ ,17,18 ▪▪ ], except one study, which reported no increase in costs only in a subgroup of PG [11]. However, the current studies demonstrate a heterogeneity of the programs‘ structure and of the included population, as a recent systematic review of Rombey et al also debated [6].…”

“…The healthcare cost reduction was mainly achieved by reducing the length of hospitalization [4,10–12,14,16 ▪ ,17]. This would also allow the hospitals to have a higher patient turnover, thus, to generate more income.…”

“…Between January 2022 and October 2023, ten studies have specifically addressed the cost balance of introducing prehabilitation programs before surgery [9 ▪ ,10–15,16 ▪ ,17,18 ▪▪ ]. Various types of programs were evaluated including physical, nutritional, and multimodal (including a combination of physical, nutritional, and psychological support).…”

“…Seven original studies analysed the cost-effectiveness of multimodal prehabilitation programs in patients scheduled for elective major digestive, cardiac, thoracic, gynaecologic surgeries, heart transplant, TKA or cancer treatment [12–15,16 ▪ ,17,18 ▪▪ ]. The studies recorded similar endpoints that included nutritional, physical and psychological status, postoperative complications, LoH and length of ICU stay, hospitalization costs, and quality of life.…”

“…A single centre, ambispective cohort study, including 46 patients scheduled for heart transplant, investigated a prehabilitation program consisting of physical prehabilitation (personalized program of moderate to high-intensity exercises and resistance training twice/week for 8 weeks, with a maintenance program until surgery consisting of one in-hospital supervised training session), nutritional prehabilitation (personalized dietary plan with protein supplementation for a goal of 1.5–2 g/kg/day) and psychological prehabilitation (a mindfulness session weekly), over a median of 14 weeks [17]. The follow-ups were done at eight weeks after program completion, at 30 days, at 3 months and at one year, and the evaluated endpoints included a detailed analysis of the costs according to hospital records.…”