Towards a common definition of surgical prehabilitation: a scoping review of randomised trials

Background: There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition. Methods: The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis. Results: We identified 76 prehabilitation trials of patients undergoing abdominal (n = 26, 34%), orthopaedic (n = 20, 26%), thoracic (n = 14, 18%), cardiac (n = 7, 9%), spinal (n = 4, 5%), and other (n = 5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n = 42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery. ' Conclusions: A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted.