The effect of prehabilitation on health resource use and 1‐year survival: an observational cohort evaluation of the active together service

Introduction

Research suggests that multi-modal prehabilitation can improve quality of life and clinical outcomes. There is, however, limited evidence on the effect of prehabilitation on hospital resource use.

Methods

This is a non-randomised observational cohort evaluation. The intervention group were patients receiving multi-modal prehabilitation (Active Together) before surgery for colorectal, lung or upper gastrointestinal cancer between January 2022 and March 2024. Patients who declined to participate in Active Together and historical patient data (2017–2021) were used as comparator groups. Outcome measures were length of hospital stay, length of critical care stay, total number of days spent in hospital as a readmission within 90 days following surgery, and one-year survival rate.

Results

Three hundred and five patients completed prehabilitation, 96 patients declined to join the service, and 869 patients were included in the historical dataset. Active Together colorectal patients spent less time in critical care than historical colorectal patients (0.9 vs 1.2 days, p = 0.011). Whereas Active Together lung patients spent longer in critical care than historical lung patients (2.5 vs 1.7 days, p < 0.001). One-year survival rate was greater in Active Together patients compared to the declined group (95% vs 85%, p = 0.013) but did not differ significantly from the historical group (95% vs 92%, p = 0.140). The probability of prehabilitation being more cost-effective than not receiving prehabilitation was 58%, 60%, and 59% for colorectal, lung and upper gastrointestinal patients, respectively.

Conclusion

The impact of prehabilitation on healthcare resource use was mixed with promising evidence of a positive effect of prehabilitation and rehabilitation on overall survival. There were notable differences between tumour groups in these outcomes which warrants further investigation. Future research is needed to build on these findings by including a larger sample size, a wider range of tumour groups, and a longer follow up period.