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November 9, 2026

Prehabilitation for Elderly Patients Before Surgery

Prehabilitation for Elderly Patients Before Surgery

For older adults facing major surgery, the weeks before the operation are an often-overlooked opportunity to improve outcomes. Prehabilitation, a structured program of exercise, nutritional optimization, and psychological support delivered before a scheduled procedure, aims to build physiologic reserves so vulnerable patients, including most elderly patients, can better withstand the stress of surgery and recover faster. For an aging, increasingly frail surgical population, the concept has moved from a promising idea to evidence-backed practice.

Prehabilitation is important for older patients who are more likely to carry reduced muscle mass, limited cardiopulmonary reserve, malnutrition, and frailty into the operating room. These factors drive postoperative complications, prolonged hospital stays, and loss of independence. Rather than accepting a patient's baseline as fixed, prehabilitation treats the preoperative period as a chance to intervene.

Large reviews of published data have found strong supporting evidence that prehabilitation for elderly patients before surgery is effective in improving post-operative outcomes. A network and component network meta-analysis of 186 randomized trials including more than 15,000 patients found that exercise-based, nutrition-based, and combined multimodal prehabilitation most likely reduced postoperative complications, with exercise and nutrition being the individual components most likely to improve critical outcomes.1 A 2026 systematic review of 23 trials reported that exercise- and nutrition-based programs lowered complication rates (odds ratio 0.52) and shortened hospital stays by roughly half a day.2

Benefits appear particularly meaningful in higher-risk groups. A meta-analysis focused on frail and high-risk patients undergoing major abdominal surgery (median age 74) found that prehabilitation reduced length of stay by about one day, cut severe complications (odds ratio 0.56), and improved six-minute walk distance by roughly 40 meters.3

Professional societies have taken notice of the benefits of prehabilitation for elderly patients before surgery. The American Society of Colon and Rectal Surgeons issued a strong recommendation for prehabilitation in frail older adults undergoing colorectal surgery, citing meta-analytic reductions in overall, pulmonary, and cardiac complications.4 The 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults acknowledges moderate-certainty evidence that prehabilitation improves functional recovery, while noting that data specific to the frailest patients remain limited.1

Anesthesia teams are uniquely positioned to lead these programs. The preoperative evaluation is a natural point to screen for frailty, sarcopenia, and malnutrition and to trigger referrals into multidisciplinary pathways. Most effective programs run for four to six weeks, pair supervised or home-based exercise with protein-focused nutrition, and add anxiety-reduction strategies.

Despite the observed benefits of prehabilitation, important questions remain regarding the optimal program intensity and duration and how best to serve the oldest and most frail patients, a group still underrepresented in trials.5 Nonetheless, one lesson is clear: investing in patients before surgery helps them recover better afterward.

References

  1. Sieber F, McIsaac DI, Deiner S, Azefor T, Berger M, Hughes C, Leung JM, Maldon J, McSwain JR, Neuman MD, Russell MM, Tang V, Whitlock E, Whittington R, Marbella AM, Agarkar M, Ramirez S, Dyer A, Friel Blanck J, Uhl S, Grant MD, Domino KB. 2025 American Society of Anesthesiologists Practice Advisory for Perioperative Care of Older Adults Scheduled for Inpatient Surgery. Anesthesiology. 2025 Jan 1;142(1):22-51. doi: 10.1097/ALN.0000000000005172. PMID: 39655991.
  2. Cascavita CT, Hall AE, Shariati K, Chevalier JM, Argame AA, Nguyen NH, Tseng CH, Hidalgo MA, Lee JC; Craniofacial Outcomes Research Team. Exercise- and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis. J Am Coll Surg. 2026 Jul 1;243(1):168-181. doi: 10.1097/XCS.0000000000001891. Epub 2026 Jun 12. PMID: 42283400.
  3. Skořepa P, Ford KL, Alsuwaylihi A, O'Connor D, Prado CM, Gomez D, Lobo DN. The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr. 2024 Mar;43(3):629-648. doi: 10.1016/j.clnu.2024.01.020. Epub 2024 Jan 22. PMID: 38306891.
  4. Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum. 2022 Apr 1;65(4):473-488. doi: 10.1097/DCR.0000000000002410. PMID: 35001046.
  5. Buckinx F, Rousseau AF, Louis E, De Roover A, Detry O, Durieux R, Gillain S, Kaba A, Kaux JF, Tchana-Sato V, Bruyère O. Effects of prehabilitation programmes on postoperative outcomes in older adults undergoing major abdominal, cardiac or vascular surgery: a systematic review. Aging Clin Exp Res. 2026 Apr 4;38(1):120. doi: 10.1007/s40520-025-03314-y. PMID: 41935176; PMCID: PMC13180763.