Effect of exercise prehabilitation on days alive and out of hospital after cardiac surgery : a secondary analysis of the randomised PRE-habilitation for improving QUality of recovery after ELective cardiac surgery trial

Abstract

Background: Postoperative healthcare utilisation and long-term survival are rarely evaluated after prehabilitation, limiting understanding of its sustained benefits. We investigated whether exercise-based prehabilitation improves percent days alive and out of hospital, a composite measure integrating recurrent hospitalisations and survival after cardiac surgery. Methods: This secondary exploratory analysis included participants with very mild to moderate frailty from the PREhabilitation for improving QUality of recovery after ELective cardiac surgery (PREQUEL) RCT. The trial time period was from 2018 to 2023 with follow-up continued until 31 December 2024, with readmissions and vital status retrospectively obtained from electronic medical records. One-inflated beta regression, negative binomial regressions, and restricted mean survival time analysis were used to estimate the effects of prehabilitation on %DAOH days alive out of hospital, cumulative hospital bed days owing to readmissions, and survival, respectively. Results: Among 136 participants (58 prehabilitation, 78 usual care), 94 (69.1%) were male, with a median age of 64 yr (IQR 59–69). Thirty-five (60.3%) prehabilitation and 52 (66.7%) usual care participants accounted for 119 and 165 readmissions, respectively. Prehabilitation was associated with a higher %DOAH days alive out of hospital in the unadjusted analysis (87.7% vs 81.5%; P=0.032), but this was not significant after adjustment (87.3% vs 83.6%; P=0.131). Cumulative hospital bed days did not differ significantly (incidence rate ratio 0.95, 95% confidence interval [CI]: 0.59–1.55). However, survival improved modestly at 4 yr (mean difference: 0.22 yr, 95% CI: 0.01–0.44; P=0.044) in favour of prehabilitation. Conclusions: Exercise-based prehabilitation had little or no effect on long-term time spent at home but may confer a modest survival benefit, warranting further investigation in larger trials.