Patient Training Program Shortens Hospital Stays

Home-based basic fitness and wellness coaching prior to surgery could reduce a patient's average hospital stay by two days, according to a new study.

Developed at the University of Michigan, the Michigan Surgical and Health Optimization Program (MSHOP) is composed of several key elements, including improving one's diet, reducing stress, breathing exercises and smoking cessation, and, most crucial, an emphasis on light physical activity, such as walking, for about an hour a day, with automated daily text messages or automated phone calls used to deliver a reminder. Each participant is given a pedometer to track progress, and a web-based risk assessment tool enables shared decision-making between the patient and his physician.

The researchers conducted a retrospective cohort study to evaluate 641 patients who participated in MSHOP, and who subsequently underwent major elective general and thoracic operative care between June 2014 and December 2015. In all, 82% of the surgical patients were actively engaged in the program, recording physical activity at least three times per week for the majority of the program. The primary outcome measures were hospital duration of stay and payer costs.

The results showed that participation in MSHOP was associated with a mean 31% reduction in hospital duration of stay, from an average of seven days to five, as well as a 28% overall reduction in costs. In addition, the researchers found that the MSHOP components not only boosted patients physical healing, but also provided them with emotional benefits in the days before the surgical procedure. The study was published early online on February 4, 2017, in Surgery.

“We do a lot in medicine to get people ready for surgery, but they're primarily administrative tasks - checking off boxes that don't necessarily make a patient better. The more you can do to manage your status preoperatively, the quicker you'll be able to bounce back,” said lead author transplant surgeon Michael Englesbe, MD. “As a physician, you always tell people to quit smoking and exercise, but the compliance rates are notoriously abysmal. Big health crises can scare people straight, so to speak, and change their lifestyle.”

“Surgery is basically controlled injury. You're ‘whacking’ patients and hoping that in the end they do better overall because you've interrupted the disease process,” added senior author Stewart Wang, MD, PhD, director of the U-M Morphomics analysis group. “The technology is scalable; expected complications or recovery difficulties could be addressed in advance with targeted training. This is just the beginning.”

MSHOP is a form of prehabilitation aimed at preventing potential injuries before the actual occurrence; the fitter the patients are when they have surgery the quicker they will recover from it. In 2013, a pilot study of prehabilitation in colorectal surgery patients found that it improved postoperative functional recovery, as measured in terms of walking capacity. It is also being considered in some cardiovascular interventions, and may also be of some benefit for preventing lung complications, such as pulmonary atelactasis, in general surgery.