Prehabilitation in frail older adults undergoing general surgery: A literature review on outcomes and best practice

Background: Individuals aged 60 years and above are undergoing surgical procedures, including resections for solid organ tumours. Surgery poses a significant physiological stress that disrupts normal homeostasis by affecting both the neuroendocrine and immune systems. When coupled with frailty, tumour-related metabolic demand and multiple co-morbidities, surgical stress predisposes older adults to poorer surgical outcomes, lower quality of life and institutionalisation. Prehabilitation aims to improve postoperative outcomes and enhance tolerance to surgical stress by optimising patients’ physical and psychological health before surgery.

Aim: This literature review aims to evaluate current literature on the effect of prehabilitation on post-operative complications in frail older adults undergoing general abdominal surgery, and attempts to determine the most effective prehabilitation interventions.

Method: A comprehensive literature search was conducted in PubMed, MEDLINE via EBSCO, Cochrane library and Google Scholar database in August 2025. Eligible studies included (1) adults aged ≥60 years, (2) classified as frail or pre-frail using standardised criteria, (3) undergoing elective abdominal surgery, (4) receiving unimodal or multimodal prehabilitation interventions and (5) published within the last 10 years.

Results: A total of 27 articles met the inclusion criteria. The majority of the prehabilitation programmes where multimodal and all involved exercise interventions. There was significant heterogeneity in the sample sizes, frailty criteria, type and length of prehabilitation carried out and outcomes reported. Colorectal surgery for tumour resection was the most common surgery reported in the prehabilitation of frail older adults. Most studies reported a significant reductions in complications and hospital length of stay and none demonstrated worse outcomes with prehabilitation.

Conclusion: Overall, prehabilitation was found to confer significant benefit with regards to intra-operative and post-operative outcomes. High-risk or frail participants seem to benefit more and adherence to multimodal programmes was better. Further research on cognitive prehabilitation and incorporation in cancer care is needed.