Prehabilitation for Thoracic Surgery Patients: A National Survey of Practice Patterns and Program Variability

BACKGROUND Prehabilitation (prehab) can improve perioperative outcomes in frail patients, yet existing thoracic surgery prehab programs are limited. We describe practice patterns in the prescription, delivery and assessment of prehab for thoracic surgery patients in the U.S. METHODS A 35-question survey was distributed (4/2025-7/2025) to one randomly selected general thoracic surgeon practicing at institutions from the 2024 STS General Thoracic Surgery Database, TSDA residency programs database, and the top 50 USNWR Best Hospitals for Pulmonology & Lung Surgery. Partially (≥70%) and complete surveys underwent descriptive statistical analysis. RESULTS From 181 institutions, 96 (53%) thoracic surgeons responded. Respondents were mostly from academic (70.8%, 68/96) centers performing median 425 (IQR: 300-800) elective thoracic operations annually. Prehab was prescribed at 47.9% (46/96) institutions, consisting of exercise (91.3%, 42/46), nutrition (82.6%, 38/46), smoking cessation (80.4%, 37/46), and mental wellness (21.7%, 10/46); most programs were outpatient or self-directed (69.6%, 32/46). Exercise sessions were most commonly prescribed for 30-45 minutes/session (54.5%, 12/22), 1-2 times/week (45.2%, 14/31), for 4-6 weeks (50.0%, 18/36). Patients were referred to prehab based on the "eyeball test" in 74.3% (26/35); formal frailty assessments were uncommon (34.3%, 12/35). Most institutions integrated prehab data into the electronic health record (51.1%, 23/45) and encouraged patients to continue prehab post-operatively (95.2%, 40/42). CONCLUSIONS Variation in the availability, content and implementation of prehab for thoracic surgery patients across the U.S. highlights the need for developing prehabilitation guidelines that can improve resource allocation, standardize data collection, and optimize perioperative and long-term outcomes for thoracic surgery patients.