Statewide Prehabilitation Program and Episode Payment in Medicare Beneficiaries

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis

“…Patients with complications were expected to require more days in a facility than those without complications. These costs were similar to the outcomes of recently published studies using Medicare claims data [ 20 ]. Prehabilitation was modeled to shorten length of stay, consistent with findings of shorter lengths of post-operative inpatient admission [ 19 35 ].…”

“…Our results are concordant with previously published research that suggests prehabilitation as a feasible and cost-effective intervention. A recent multicenter study in Michigan demonstrated that prehabilitation decreased hospital length of stay and total episode payments [ 20 ], and also supported the feasibility of prehabilitation programs in varied practice settings. A similar intervention for patients undergoing major abdominal surgery at a single institution found a decreased rate of major complications, with resultant cost savings of $21,946 per patient undergoing colectomy [ 24 ].…”

“…Common components include protein supplementation, medical optimization of co-morbid conditions, aerobic and resistance exercises, pulmonary therapy, and stress and anxiety management. Program duration can vary from the week prior to surgery to a period of months prior to procedure, via in-person visits or telemedicine [ 20 21 ].…”

Care of the Geriatric Colorectal Surgical Patient and Framework for Creating a Geriatric Program: A Compendium From the 2019 American Society of Colon and Rectal Surgeons Annual Meeting

“…Although the optimal prehabilitation program is different based on a variety of factors for each patient, several authors have developed in-home prehabilitation models, and preliminary data have shown decreased length of stay, more likely discharge to home, and decreased costs. 24 , 25 Some combination of office-based and home-based prehabilitation is likely the optimal program currently, but this is rapidly evolving and should be patient-centered.…”

Evaluation of a New Model of Postoperative Care: A Preliminary Cost-effectiveness Analysis Using Markov Modelling

“…For example, in a recent ERAS umbrella systematic review 6 , only 13 of over 200 studies even mentioned cost as an outcome. Those studies that do address cost and effectiveness frequently including simple estimates, or formal but simple cost-effectiveness calculations [13][14][15][16][17] . One recent systematic review of interventions to reduce hospital stay concluding that, overall, the evidence base is poor, and costs are rarely dealt with effectively 18 .…”