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Length Of Stay After Enhanced Recovery With Integrated Selective Prehabilitation
Maria G. Lopez Trevino, Marcell Szekely, Istvan I. Gecse, Michael Reardon, Reul M. Ross, Marvin D. Atkins, Andrea G. Quarti, Fernando Ramirez Del Val.
Houston Methodist Hospital, Houston, TX, USA.
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways have been shown to improve perioperative outcomes in cardiac surgery; however, real-world implementation remains variable. Integration of selective prehabilitation within enhanced recovery pathways may further optimize recovery before surgery.
METHODS: A multidisciplinary ERAS pathway with integrated selective prehabilitation was implemented in adult on-pump cardiac surgery patients. Standardized preoperative evaluation included Society of Thoracic Surgeons (STS) risk assessment, frailty screening, structured patient education, enhanced recovery-specific laboratory testing, medication and fasting instructions, and coordinated pre-admission testing. Eligibility criteria included elective isolated coronary artery bypass grafting (CABG), STS predicted risk of mortality ≤4, and absence of acute end-organ failure or cardiogenic shock. Selective prehabilitation was a defined component of the enhanced recovery pathway and was initiated preoperatively in eligible patients based on frailty, defined as at least one affirmative response on The Simple FRAIL Questionnaire, assessing functional capacity, mobility, nutritional status, and baseline physical activity. Prehabilitation interventions included functional assessment, inspiratory muscle training, nutritional optimization, and lifestyle counseling. Elective isolated CABG patients enrolled in the enhanced recovery pathway with integrated selective prehabilitation were compared with a contemporaneous cohort of elective CABG patients who met eligibility criteria but were not enrolled due to operational factors. Postoperative length of stay (LOS) was tracked and summarized descriptively.
RESULTS: From June through November 2025, 47 elective CABG patients were enrolled in the enhanced recovery pathway with integrated selective prehabilitation and were compared with 156 contemporaneous eligible but non-enrolled patients. Mean postoperative LOS was 6.39 ± 0.84 days among enhanced recovery patients with selective prehabilitation and 8.24 ± 0.80 days among non-enrolled patients, corresponding to an absolute difference of 1.9 days
.CONCLUSIONS: Among elective CABG patients eligible for enhanced recovery, enrollment in a standardized enhanced recovery pathway with integrated selective prehabilitation was associated with shorter observed postoperative LOS compared with a contemporaneous eligible but non-enrolled cohort. These findings support the feasibility of incorporating frailty screening-guided prehabilitation as an integral component of enhanced recovery pathways and support expansion of enrollment to determine whether these recovery benefits are reproducible and sustained across broader populations.
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