Prehabilitation interventions for patients on elective surgical waiting lists: a topic evidence summary

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Introduction

Waiting times for elective surgery in the NHS are at record highs. Long waits can harm patients’ health and lead to worse outcomes. Prehabilitation means helping patients improve their health before surgery. It often includes lifestyle changes like exercise, nutrition, smoking cessation, and support to reduce risks, improve surgical outcomes, aid recovery and long-term wellbeing.

We developed this topic evidence summary to identify which prehabilitation interventions for adults on elective surgical waiting lists are effective and what features or components make these interventions successful.

Main points

How up to date is this evidence?

We produced this topic evidence summary in 2023 and included studies published in English from 2011 onwards.

What we found

• In total, we included 57 primary studies, 12 from the UK and none from Wales.
• We produced nine evidence summaries covering a range of prehabilitation interventions, including psychological support, alternative therapies, and lifestyle changes such as exercise, nutrition, and smoking cessation. These were delivered alone or in combination across different surgical specialties.
• We produced a separate report summarising UK‑only evidence.
• This section provides a short overview; please refer to the full report for detailed evidence statements for each intervention category.

What this means

• The evidence base varied by intervention and outcome, so findings should be treated as indicative rather than definitive.
• These topic evidence summaries are intended to support national and local decision‑making by giving a broad view of which interventions have been studied and where evidence appears promising. It may be used to initiate early conversations about services and programmes, highlight options that may be worth exploring locally, and flag approaches that current evidence suggests should be avoided for now.
• These topic evidence summaries are not designed tobe used on their own to allocate resources or make detailed comparisons between competing priorities. They do not provide detailed information on study quality, costs, or effect sizes, and they are not designed to offer locally tailored recommendations. They also do not aim to cover every possible intervention.

Technical information

This topic evidence summary draws on studies from a rapid review by Okolie et al. (2022) and a top‑up search completed in March 2023. For full details of the search, inclusion criteria, quality assessment, and synthesis, please refer to the main report.

We included English‑language studies published from 2011 onwards, focusing on prehabilitation interventions with an educational component in OECD countries. Studies were screened against our criteria, grouped by intervention and surgery type, and data were extracted. We used a simple traffic‑light key to indicate what the overall evidence suggests for each outcome: Green for interventions that may help, Yellow for those needing more research, and Red for those unlikely to help.

Glossary

Prehabilitation or prehab: Steps the patient and their key healthcare workers undertake together before their treatment or surgery to improve their physical and mental wellbeing. These typically include exercise, nutrition support, smoking cessation, and psychological preparation to enhance recovery and reduce complications.

OECD countries: The Organisation for Economic Co-operation and Development (OECD) comprise 38 member countries, primarily developed, market-based economies committed to democratic principles. They tend to have similar health systems, making research more comparable to the UK.