Patient Training for Surgery Can Lead to Shorter Stays, Lower Costs

A Michigan program develops personalized “prehabilitation” plans for patients, leading to a sound mind and body – and a “bit of control” over their outcomes.

New research shows there is a way to reduce the length of hospital stays by 30 percent, but not everyone is jumping onboard. It’s all about training a patient for surgery.

“An athlete would prepare for an athletic endeavor; a patient should train for an operation,” says Michael Englesbe, MD, a transplant surgeon and a professor of surgery at the University of Michigan in Ann Arbor. “I personally think every patient should train for surgery.”

MSHOP was founded by Stewart Wang, MD, PhD, and Michael Englesbe, MD. The program helps patient target and strengthen weaknesses before surgery. | University of Michigan

About 90 percent of the surgeries in the United States are elective, so patients often have time to prepare, Englesbe says. This involves staples of wellness, including walking or other physical activity, eating better, breathing exercises and smoking cessation, and stress reduction - as well as preparing for post-surgery pain management.

“A two-hour operation takes as much out of a patient as running a 5K as fast as they can. Surgery is physiologically hard on patients,” he says. “Training helps them become stronger for surgery, which makes them better prepared to recover after surgery.”

This “prehabilitation” also helps patients psychologically, giving them something to do while waiting for their surgery date to arrive ‑ and a bit of control over their outcomes.

“I think it’s part physiologic and part psychologic. For some patients, one will matter more than the other,” Englesbe says. “Patients who go through this felt empowered and it helps them manage the stress of surgery.”

With these factors in mind, Englesbe and trauma surgeon Stewart Wang, MD, PhD, created the Michigan Surgical and Health Optimization Program , which helps patients target and strengthen their weaknesses before surgery.

Since MSHOP began five years ago, more than 2,000 patients at more than 40 hospitals and medical practices in the state have participated.

An analysis of the patients’ medical imaging and other data – a specialty known as morphomics – is used to tailor their programs. They train from the day they find out about their surgery until the day before the operation. The program starts with an appointment in a preoperative clinic and continues with automated text and phone messages to remind patients about training goals.

“We estimate it takes about an hour of staff time per patient to be in the program,” Englesbe says.

The results, published in Surgery , show the training can reduce an average hospital stay by about two days, down from seven days to five. It also saved an average of about $2,300 in hospital costs, according to the program.

“Patients are in the hospital less time and it costs the hospitals less to care for them,” says Englesbe, who adds patients also love that they get to go home sooner.

Even with these outcomes, adoption of the program has been slow.

“It’s hard to change a surgeon’s habits, but we’ve had some success,” he says.

Also, hospitals have not been quick to embrace the practice, even though at least one insurance company in Michigan is allowing surgeons and staff to bill for the service. Getting organizations to increase workload is difficult.

“One of the biggest pressure points for any hospital administrator is staff busy-ness,” Englesbe says. “It’s really hard to change practice, but we’re making progress. This is one more thing, and any caregiver knows it’s good for the patients, but it just takes time. It just makes sense. It’s a cheap way to change people’s lives and cut costs.”

Englesbe says change has to come from within.

“Recruit a surgeon or anesthesiologist or nurse who cares a lot [about training] to drive this change among caregivers,” he says. “The best way to disengage surgeons is to talk about the financial benefits for the hospital. The strategy for success is to talk about the benefit to the patient. Financial benefits are for boardrooms, not for doctor’s offices.”