Integrating Prehabilitation into Surgical Pathways: Current Modalities, Outcomes, and Research Gaps.

Abstract

Background: Prehabilitation constitutes a multidisciplinary strategy aimed at optimizing patients' physiological and psychological status prior to surgery, with the objective of improving postoperative outcomes and long-term quality of life. Interventions commonly include structured exercise programs, nutritional optimization, respiratory muscle training, and psychosocial support. This narrative review synthesizes the expanding body of evidence on prehabilitation, with particular emphasis on the implementation of diverse modalities, their impact on surgical outcomes, and the persisting gaps in knowledge that warrant further investigation.

Methods: A systematic PubMed search was performed on June 25, 2025, using the terms "Prehabilitation AND Anesthesia," "Prehabilitation AND Surgery," "Prehabilitation AND Preoperative Medicine," and "Prehabilitation." Extracted data included article title, year of publication, surgical specialty, procedure type, study design, prehabilitation modality, number of modalities, regimen duration, demographic characteristics, loss to follow-up, cancer status or receipt of neoadjuvant chemotherapy, study outcomes, data collection methods, and study conclusions. Systematic reviews, meta-analyses, protocol descriptions, and feasibility studies without reported results were excluded from the final analysis.

Results: The search strategy identified 796 articles, 76% of which were published between 2017 and 2025. A total of 153 studies met inclusion criteria for analysis. The most frequently represented surgical specialties were general surgery (43%), orthopedic surgery (21%), and cardiothoracic surgery (18%). Single-modality prehabilitation was reported in 43% of studies, whereas multimodal approaches varied by specialty, occurring in 36% of general surgery studies and 13% of cardiothoracic surgery studies. Five principal prehabilitation modalities were identified: exercise, nutrition, psychological intervention, substance cessation, and medical optimization. Exercise-based interventions were the most common, incorporated in 84.7% of studies, followed by nutritional interventions in 29.5%. Overall, 82% of included studies reported statistically significant improvements in surgical outcomes associated with prehabilitation.

Conclusion: Most studies included in this review demonstrated a significant positive impact of prehabilitation on surgical outcomes. Nonetheless, most investigations employed a single prehabilitation modality, underscoring the need to further assess the effectiveness of multimodal strategies. Furthermore, the existing evidence is concentrated within a limited number of surgical specialties, highlighting the necessity for well-designed studies across a broader spectrum of surgical disciplines.