Perioperative medicine & outcomes
Effects of multimodal prehabilitation on surgery outcomes: prospective stepped-wedge, hospital-wide implementation study
Authors' conclusion
Hospital-wide implementation of multimodal prehabilitation did not reduce postoperative complications or length of hospital stay.
Study context
- Population
- Patients undergoing elective surgery across 20 clinical pathways, Radboudumc, Nijmegen, The Netherlands, March 2019 to April 2024
- Participants
- 4,131 patients
- Exposure
- Multimodal prehabilitation vs standard preoperative care
- Usual caren = 2,660reference
- Prehabilitationn = 1,471
- Outcome
- Incidence and severity of postoperative complications (Clavien-Dindo grade ≥II; dichotomized Comprehensive Complication Index)
- Follow-up
- 30 days
Methodological detailssingle-centre, non-randomized, hospital-wide implementation
- Single-centre
- Non-randomized
- Hospital-wide implementation
Main finding
As reported in the abstract
Postoperative complications within 30 days
Clavien-Dindo (CD) grade ≥II complications, prehabilitation vs usual care: adjusted RR, no significant difference
1.02
95% c.i. 0.90 to 1.16
Comprehensive Complication Index (CCI) >22.6, prehabilitation vs usual care: adjusted RR, no significant difference
1.03
95% c.i. 0.86 to 1.23
Observational data: associations, not effects.
Secondary outcomes
Hospital LOS
- Prehabilitation vs usual care: adjusted IRR, no significant difference
- 1.04 (95% c.i. 0.92 to 1.18)
CD grade ≥II complications, high-risk gastrointestinal (GI) oncological surgery (subgroup, 1230 patients)
- Prehabilitation vs usual care: adjusted RR; 9% relative reduction, not statistically significant
- 0.91 (95% c.i. 0.75 to 1.10)
Original publication
Effects of multimodal prehabilitation on surgery outcomes: prospective stepped-wedge, hospital-wide implementation study. Br J Surg. Published 17 February 2026. doi:10.
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