Development and Mixed-Methods Evaluation of the Prehabilitation for Facial Feminization Surgery (PREFACE) Program

Background: To strengthen preoperative preparation and improve clinical outcomes, a multimedia prehabilitation program was created for patients undergoing facial feminization surgery.This study evaluates the program and its impact on clinical outcomes.Methods: PREFACE includes five video modules, a guidebook, and a mobile application covering surgical information, preoperative preparation, and postoperative recovery.Program feasibility and acceptability was evaluated via a mixed-methods approach utilizing the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.Clinical outcomes were evaluated in a hybrid prospective-retrospective cohort of 144 FFS patients (PREFACE=32, comparison=112), including hospital length of stay, 30-day complications, inpatient pain, and perioperative opioid use (morphine equivalent dose/kg).A subgroup analysis evaluated postoperative messages and phone calls one month after surgery as well as pain during the first week as an ecological momentary assessment (EMA) using the PROMIS Pain Intensity Scale.Results: Among PREFACE participants enrolled during the first six months, engagement was 94.4%, with satisfaction averaging 9.11.1.The guidebook was the most utilized format (82.3%), followed by the mobile application (58.8%).The clinical team reported straightforward adoption and integration into existing workflows.Compared with controls, PREFACE participants had lower inpatient pain (1.7(IQR:1.9)vs 2.8(IQR:2.3),p=0.03) and postoperative messages and phone calls (1.0(IQR:2.75)vs (2.0(IQR:4.0),p=0.01).Among EMA responders, PREFACE J o u r n a l P r e -p r o o f participants reported lower PROMIS Pain Intensity scores 4-5 days postoperatively (3.5(IQR:2.3)vs 5.5(IQR:2.8),p=0.02). Conclusion:The PREFACE program is a feasible and well-accepted multimedia prehabilitation intervention that was associated with reduced postoperative communication as well as pain during hospitalization and in the first postoperative week.