• Jorge G Zarate Rodriguez, Heidy Cos, Melanie Koenen, Jennifer Cook, Christina Kasting, Lacey Raper, Tracey Guthrie, Steven M Strasberg, William G Hawkins, Chet W Hammill, Ryan C Fields, William C Chapman, Timothy J Eberlein, Benjamin D Kozower, and Dominic E Sanford.
• From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford).
• J. Am. Coll. Surg. 2023 Sep 1; 237 (3): 558567558-567.

BackgroundThe preoperative period is an important target for interventions (eg Surgical Prehabilitation and Readiness [SPAR]) that can improve postoperative outcomes for older patients with comorbidities.Study DesignTo determine whether a preoperative multidisciplinary prehabilitation program (SPAR) reduces postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients, surgical patients enrolled in a prehabilitation program targeting physical activity, pulmonary function, nutrition, and mindfulness were compared with 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 were compared. The ACS NSQIP Surgical Risk Calculator was used to compare observed-to-expected ratios for postoperative outcomes.ResultsA total of 246 patients were enrolled in SPAR. A 6-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 with pre-SPAR NSQIP patients (n = 4,028), SPAR patients were significantly older with worse functional status and more comorbidities. Compared with 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 postacute care facilities (6.5% vs 15.9%, p = 0.014). Similarly, SPAR patients exhibited decreased observed 30-day mortality (observed-to-expected ratio 0.41) and need for discharge to a facility (observed-to-expected ratio 0.56) compared with their expected outcomes using the ACS NSQIP Surgical Risk Calculator.ConclusionsThe SPAR program is safe and feasible and may reduce postoperative mortality and the need for discharge to postacute care facilities in high-risk surgical patients.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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