Effectiveness of Prehabilitation Programs on Perioperative Outcomes

Abstract

Prehabilitation, the structured optimization of a surgical patient's physical, nutritional, and psychological status before an operation, has expanded from a niche enhanced-recovery concept into a widely studied perioperative strategy across abdominal, thoracic, cardiac, and spine surgery. This review synthesizes the comparative and pooled evidence for exercise-based, nutritional, and multimodal prehabilitation programs, drawing on recent systematic reviews and meta-analyses spanning colorectal, upper abdominal, esophagogastric, cardiac, and lung resection surgery. The evidence most consistently favors prehabilitation in frail, sarcopenic, or functionally compromised patients, where multiple meta-analyses report reduced postoperative complications, shorter length of stay, and improved functional recovery, while benefit in fit, well-nourished patients is smaller and less consistently demonstrated. Multimodal programs combining exercise, nutrition, and psychological support generally outperform single-domain interventions, though heterogeneity in program design and outcome reporting, along with real-world adherence challenges, complicate direct comparison across trials. We conclude that frailty- and nutrition-based screening to target prehabilitation resources toward the patients most likely to benefit, alongside better integration with enhanced recovery pathways, represents the most promising direction for translating trial-level efficacy into routine perioperative practice.