BACKGROUND AND AIMS: Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery. METHODS: We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs). RESULTS: The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with rehabilitation or standard pre- and post-surgical care. CONCLUSION: Prehabilitation was acceptable to patients, with good adherence, and improved physical function.

3rd Department of Internal Medicine Metabolic Care and Gerontology University Hospital and Faculty of Medicine in Hradec Králové Charles University Prague Hradec Králové Czech Republic https twitter com Pavel_Skorepa

Department of Agricultural Food and Nutritional Science University of Alberta Edmonton Canada https twitter com DrCarlaPrado

Department of Clinical Nutrition King Saud Medical City Ministry of Health Riyadh Saudi Arabia https twitter com AbdulAz1z4_4

Divison of Surgery Perelman School of Medicine University of Pennsylvania Philadelphia PA USA

MRC Versus Arthritis Centre for Musculoskeletal Ageing Research School of Life Sciences University of Nottingham Queen's Medical Centre Nottingham UK

National Institute for Health Research Nottingham Biomedical Research Centre Nottingham University Hospitals and University of Nottingham Queen's Medical Centre Nottingham UK

Nottingham Digestive Diseases Centre Division of Translational Medical Sciences School of Medicine University of Nottingham Queen's Medical Centre Nottingham UK

School of Health Sciences University of Nottingham Queen's Medical Centre Nottingham UK https twitter com Dom_OConnor1

University of Defence Military Faculty of Medicine Department of Military Internal Medicine and Military Hygiene Hradec Kralove Czech Republic

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