In a healthcare system that has long treated surgery as the starting point, Omaha-based OrthoNebraska is quietly shifting the timeline.
Inside its orthopedic hospital, preparation begins weeks before the first incision — not with imaging or scheduling, but with movement. Patients practice how they will live after surgery before they ever experience it.
The program is called “prehabilitation.” Its function is simple, and more consequential: it shifts where surgery begins.
Redesigning the front end of orthopedic care
For many patients, the surgical journey has traditionally been compressed into a narrow window, a consultation, a procedure and a rapid transition into recovery.
Kristina Miller, RN, manager of pre and post and extended recovery, saw the limitations of that model in how patients absorb information and prepare for what comes next. “We really want to individualize the care for our patients,” she said. “They have a lot of different information and things coming at them all at once.”
That volume of information, often delivered close to the date of surgery, can be difficult to process, particularly when paired with anxiety.
“We always try to look to see how we can prepare them for this journey right from the start,” Ms. Miller said.
At OrthoNebraska, that preparation now begins with a dedicated prehab visit, where patients meet one-on-one with therapy teams to walk through the realities of recovery before surgery takes place, while they are still mobile, clear-headed and able to engage.
The role of familiarity in recovery
For Michael Stojanovic, MD, an orthopedic surgeon at OrthoNebraska, one of the most important benefits of prehabilitation is not physical, but psychological.
“It’s a huge mental advantage for the patient,” he said.
Patients are introduced to members of the care team and the broader environment before surgery, creating a sense of familiarity that carries into recovery. “They meet key members of the team beyond my office, which involves our nurses, our [physical therapy], [occupational therapy], our facility,” Dr. Stojanovic said.
That exposure reduces the friction of entering an unfamiliar setting, and gives patients time to ask questions they may not think of during a standard clinic visit.
Preparing patients for shorter stays
The rise of prehabilitation reflects broader changes in orthopedic care, particularly the shift away from extended hospital stays.
“You’ve seen essentially, especially since COVID, this dramatic shift outside of the hospital,” Dr. Stojanovic said.
Patients who once remained hospitalized for several days after joint replacement are now often discharged within 24 hours, a transition that demands more comprehensive preparation before surgery. “It’s basically all-encompassing … approaching the patient from different angles to prepare them, set expectations and really demystify their questions,” he said. “I think that goes a long way in their recovery, even more than any individual type of physical therapy or medication to control pain,” he added.
At OrthoNebraska, that preparation is reinforced across multiple touchpoints, from clinic visits to nurse navigation to prehab, creating a coordinated, team-based approach that extends beyond any single encounter.
Confidence as a clinical outcome
For patients, the most immediate impact of prehabilitation is confidence. “What we see the most is just the confidence that they have going home,” Ms. Miller said.
That confidence is built through hands-on preparation, particularly around everyday movements that become more difficult after surgery. “You take for granted going up and down stairs and getting in a car when you have your full capability,” she said.
By practicing these scenarios in advance, patients enter recovery with a clearer understanding of what will be required, and fewer unknowns waiting at home.
Identifying risk before it becomes a problem
Prehabilitation also creates space to identify potential challenges before they affect outcomes. During these sessions, therapy teams may recognize when a patient needs additional support, whether physical, logistical or social.
“And so then we question, is this the right time for this patient to have surgery,” Ms. Miller said.
That early insight allows the care team to adjust plans proactively, rather than reacting after surgery.
“It’s an opportunity to address when higher needs are required,” Dr. Stojanovic said. In that sense, prehabilitation functions not only as preparation, but as prevention.
Expanding care beyond the patient
Another key element of the program is the inclusion of caregivers, individuals who often play a central role once the patient returns home.
Patients frequently attend surgical consultations alone. Prehab creates an opportunity to bring in a second set of eyes and ears. “That person is a huge advantage and resource as well,” Dr. Stojanovic said.
It is a small shift, but one that can materially change how patients navigate recovery, reinforcing instructions, reducing uncertainty and providing continuity once they leave the hospital.
From innovation to expectation
As programs like this evolve, they are beginning to shape expectations around surgical care itself. “I think it’s pretty much going to be required,” Dr. Stojanovic said.
The shift reflects a broader movement toward continuity, aligning teams, reinforcing expectations and preparing patients as individuals rather than cases. In that model, surgery is no longer the starting point. It is one step in a process that begins long before the operating room.
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