Impact of prehabilitation on patient-perceived quality of recovery after surgery: prospective cohort study

Abstract

Background: Multimodal prehabilitation has the potential to reduce complications, shorten hospital stays, and decrease healthcare resource utilization. However, its impact on patient-centred outcomes, such as patient reported-outcomes, has been less extensively studied. This study assessed the effect of multimodal prehabilitation on patient-perceived quality of recovery following elective surgery.

Methods: This was a prospective cohort study of patients undergoing elective gastrointestinal surgery between 1 February 2024 and 28 February 2025 who met institutional criteria for prehabilitation. Outcomes, including comparing postoperative complications, length of hospital stay, and perceived recovery, were compared between patients who completed the prehabilitation program and those who did not (control cohort). The primary outcome measure was the Quality of Recovery-15 (QoR-15) questionnaire score.

Results: In all, 188 patients were included in the study. The 94 patients who completed the prehabilitation program over a mean(standard deviation) of 4.5(1.6) weeks had fewer postoperative complications per patient than did patients in the control group (mean(standard deviation) 1.0(1.4) versus 1.4(1.4); P = 0.008). In addition, mean(standard deviation) QoR-15 scores were significantly higher in the prehabilitation than control group at baseline (129.5(15.0) versus 122.9(17.0); P = 0.003), discharge (117.2(14.0) versus 106.8(15.0); P < 0.001), and 30 days after discharge (128.2(16.0) versus 118.5(14.0); P < 0.001). At 30 days after discharge, 66% of patients in the prehabilitation group had recovered all three pre-identified essential activities, compared with 35% in the control group (P = 0.001).

Conclusions: The findings suggest that prehabilitation not only reduces postoperative morbidity and facilitates physical recovery but also enhances patients' subjective experience of recovery throughout the surgical journey, supporting its integration into routine perioperative care for digestive surgery.

Keywords: QoR-15; gastrointestinal surgery; multimodal prehabilitation; patient-reported outcome measures; postoperative recovery; preoperative care.

Fig. 1

Flowchart of study enrolment

Fig. 2

Estimated marginal means of QoR-15 scores across study cohorts and time points Mean estimated marginal means of QoR-15 scores at baseline (T0), TD, and T30 for the prehabilitation and control cohorts. The prehabilitation cohort consistently showed higher recovery scores across all time points. Error bars represent the standard deviation. QoR-15, Quality of Recovery 15-item questionnaire; T0, before surgery; TD, discharge day; T30, 30 days after surgery.

Fig. 3

Sankey diagram showing changes in QoR-15 scores over time The diagram shows the changes in the number of patients in each QoR-15 category (excellent, good, moderate, poor) from baseline (T0) to TD and T30 in the a prehabilitation and b control cohorts. Patients in the prehabilitation group maintained a more stable distribution across categories over time, with fewer patients shifting towards worse QoR-15 categories at TD and a greater proportion returning to higher categories by T30, compared with the control cohort. QoR-15, Quality of Recovery 15-item questionnaire; T0, before surgery; TD, discharge day; T30, 30 days after surgery.

Fig. 4

QoR-15 scores at hospital discharge by cohort and complication status QoR-15 scores in patients in the prehabilitation and control cohorts, with and without complications. The boxes show the interquartile range, with the median value indicated by the horizontal line; whiskers show the range. The mean (standard deviation) QoR-15 scores (‘X’) were 113.5 (15.1) and 120.2 (11.1) in the prehabilitation cohort with and without complications, respectively, and 105.0 (15.9) and 110.0 (13.0) in the control cohort with and without complications, respectively. QoR-15, Quality of Recovery15-item questionnaire; c.i., confidence interval.