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Gerofit Prehabilitation Pilot Program

Preparing Frail Older Veterans for Surgery

Dworsky, Jill Q.; Castle, Steven C.; Lee, Cathy C.; Singh, Sumit P.; Russell, Marcia M.

The Journal for Healthcare Quality (JHQ): March/April 2019 - Volume 41 - Issue 2 - p 91–98
doi: 10.1097/JHQ.0000000000000185
Original Article
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ABSTRACT Older Veterans are increasingly undergoing surgery and are at particularly high risk of postoperative morbidity and mortality. Prehabilitation has emerged as a method to improve postoperative outcomes by enhancing the patient's preoperative condition. We present data from our prehabilitation pilot project and plans for expansion and dissemination of a nationwide quality improvement effort. The infrastructure of the existing Veterans Affairs (VA) Gerofit health and exercise program was used to create our pilot. Pilot patients were screened for risk of postoperative functional decline, assessed for baseline physical function, enrolled in a personalized exercise program, and prepared to transition into the hospital for surgery. Patients (n = 9) completed an average of 17.7 prehabilitation sessions. After completing the program, 55.6% improved in ≥2 of the 5 fitness assessments completed. Postoperative outcomes including complications, 30-day mortality, and 30-day readmissions were better than predicted by the National Surgical Quality Improvement Program Surgical Risk Calculator. We have obtained institutional support for implementing similar prehabilitation programs at VA hospitals nationally through our designation as a VA Patient Safety Center for Inquiry. This is the first multi-institutional prehabilitation program for frail, older Veterans and represents an essential step toward optimizing surgical care for this vulnerable population.

For more information on this article, contact Jill Q. Dworsky, jklausner@mednet.ucla.edu.

Funders: J. Q. Dworsky receives funding from the Agency for Healthcare Research and Quality (grant T32HS00046) and the American College of Surgeons (grant 20170835). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. M. M. Russell is a consultant for Healthgrades and the American College of Surgeons, and receives funding from the Conquer Cancer Foundation of ASCO, the National Institute on Aging (grant 1R03AG056350-01), and VA Health Services, Research & Development (grant 1I01HX002278-01A1). This project was funded by the VHA Office of Rural Health and the VHA Office of Geriatrics and Extended Care. The remaining authors have no conflicts of interests to disclose.

© 2019 National Association for Healthcare Quality
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