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Background: Recent research emphasises that prehabilitation may reduce postoperative complications after major abdominal surgery. Evidence that prehabilitation also has financial benefits may accelerate the implementation of prehabilitation programs in daily care. The aim of this study was to describe the development of a flexible tool to calculate the return on investment of a multimodal prehabilitation program.

Methods: The tool is based on a multimodal prehabilitation program that includes five patient-related risk factors and associated interventions: low physical fitness (physical therapy), impaired nutritional status (consultation with a dietician), the presence of iron deficiency anaemia (iron injection), smoking behaviour, and alcohol abuse (consultation with an addiction specialist). The tool calculates the financial benefits of the prehabilitation program based on the difference in estimated complicationrelated in-hospital costs in the scenarios with and without the prehabilitation program. Pancreatic surgery was used as an example. The final outcome of the tool is the ratio of returns to investments.

Results: In a Dutch academic centre the average hospital cost per patient who underwent pancreatic surgery without preoperative interventions was€ 32,625. The scenario analysis showed that, if all prehabilitation interventions were provided, in-hospital costs could be reduced to€ 29,870 through reduced complication rates, thus rendering a cost saving per patient of€ 2,755. The cost of providing all necessary interventions were estimated to be on average€ 774 per patient. The return on investment was calculated to be 3.56.

Conclusion: The online …