Operational

Prehabilitation

Also known as: prehab, preoperative optimisation, surgery preparation

Prehabilitation is structured preparation before surgery — typically exercise, nutrition and psychological support, alongside smoking and alcohol reduction — aimed at improving a patient's physiological reserve before the stress of an operation. It treats the wait for surgery as an intervention window rather than dead time, which requires identifying who would benefit early enough to act.

Typical components
Exercise, nutrition, psychological support, smoking and alcohol reduction
Aim
Improve physiological reserve before the stress of surgery
Window
The period between listing and operating
Best suited to
Patients with reduced functional capacity or frailty facing major surgery

The waiting list as an intervention window

The premise is straightforward. A patient waiting weeks or months for elective surgery is usually waiting passively. Prehabilitation asks what that period could be used for, particularly for patients whose functional capacity is low or who show signs of frailty — the people for whom the physiological demand of surgery sits closest to their reserve.

Its dependency is identification, not delivery

Services that attempt prehabilitation tend to discover that the programme is not the hard part. The hard part is knowing, early enough, which patients should be in it.

Deciding that requires functional capacity and frailty to have been assessed across the whole booked list, not just among patients who have already reached a clinic. And it requires that assessment to happen near the point of listing, because a referral into prehabilitation two weeks before surgery has almost no window to work in.

That is the same constraint that governs anaemia correction and glycaemic optimisation, and it is why screening every booked patient early changes what a service is able to offer, not just how efficiently it runs.

Related terms

Functional capacity (METs)

Functional capacity describes how much physical activity a patient can perform, measured in metabolic equivalents (METs). One MET is resting oxygen consumption. Four METs — climbing a flight of stairs or walking up a hill — is the usual threshold below which perioperative guidelines suggest further cardiac assessment before non-cardiac surgery.

Frailty

Frailty is a state of reduced physiological reserve across multiple systems, leaving a patient vulnerable to stressors such as surgery. It independently predicts post-operative complications, longer stays, loss of independence and mortality — over and above age, ASA class or the specific procedure — which is why it is screened separately before elective surgery.

Enhanced Recovery After Surgery

Enhanced Recovery After Surgery is a structured approach that bundles evidence-based steps across the whole surgical pathway to reduce the physiological stress of surgery and speed recovery. A substantial part of it is pre-operative — optimising comorbidity, correcting anaemia, avoiding prolonged fasting and preparing the patient — which makes early assessment a precondition rather than an adjunct.

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