Prehabilitation in General Surgery: Current Evidence, Clinical Applications and Future Directions

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Prehabilitation has emerged as an important component of modern perioperative medicine, aiming to optimize patients before surgery rather than focusing solely on postoperative recovery. In general surgery, patients frequently present with reduced physiological reserve, frailty, sarcopenia, malnutrition, anemia, poor cardiopulmonary fitness, psychological distress, and multiple comorbidities, all of which may impair tolerance to surgical stress and increase the risk of postoperative complications. This narrative review summarizes current evidence, clinical applications, and future perspectives of prehabilitation in general surgery. Prehabilitation is best understood as a structured, risk-directed preoperative strategy that may include exercise training, nutritional optimization, psychological support, respiratory training, anemia management, smoking and alcohol cessation, and optimization of chronic diseases. Its biological rationale is based on enhancing physiological reserve before the metabolic, inflammatory, neuroendocrine, and immune stress response induced by surgery. Current evidence suggests that prehabilitation may improve selected outcomes, particularly functional capacity, postoperative recovery, complications, and length of hospital stay, with the strongest data currently available in colorectal and major abdominal surgery. However, substantial heterogeneity in patient selection, intervention protocols, adherence, outcome definitions, and implementation strategies limits the ability to recommend a single universal model. Prehabilitation should therefore be integrated with Enhanced Recovery After Surgery pathways as part of individualized, risk-stratified perioperative care. Future progress will depend on standardized definitions, pragmatic trials, cost-effectiveness analyses, implementation science, and the development of digitally supported, home-based, and precision prehabilitation models.