A surgeon-focused view of how prehabilitation is being used before major elective procedures, where the clinical return appears strongest, how patients are selected, what happens when the pre-op window is short, and which workforce, digital, and reimbursement changes could move prehab from selective practice to a routine pathway.
Audience: Surgeons
Countries: 6
Completion Rate: 81.9%
SGID: 8944147
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Prehabilitation asks a surgical team to improve a patient’s functional reserve before surgery rather than waiting until the postoperative period to rebuild it. In practice, that can mean nutrition, exercise, anemia and medical optimization, smoking cessation, psychological preparation, and education delivered within a finite pre-op window.
Structured preoperative optimization is increasingly supported: the ACS Strong for Surgery program folds prehab into preoperative risk-reduction checklists, the ERAS Society keeps publishing specialty guidance (including 2025 colorectal recommendations), and the UK Centre for Perioperative Care issued 2025 prehab guidance for people with cancer. The evidence, though, is still heterogeneous, a 2026 ACS summary of 23 randomized trials found better aggregate outcomes with exercise- and nutrition-based prehab, while procedure-specific reviews show clearer gains in functional capacity than in complications, so the survey question is not whether preparation matters but how much can realistically be standardized across procedures, risk profiles, teams, and timelines.
36.8% say prehabilitation is routine standard of care for all major elective surgical procedures.
Beyond the 36.8% routine, adoption splits across selective use for high-risk or frail patients (22.1%), informal ad-hoc advice (20.6%), no formal program (17.6%), and pilots (2.9%), so this is neither early experimentation nor full normalization but a mixed landscape. The practical consequence is that whether a surgeon can offer prehab still depends on institution, specialty, allied-health capacity, and whether the patient clears a high-risk threshold, so the real next step is defining who enters, when referral triggers, and who owns each component, not simply launching a program.
44.1% identify major elective orthopedic or joint replacement surgery as the patient population with the highest clinical return from multimodal prehabilitation.
Orthopedic and joint replacement leads perceived return at 44.1%, with complex oncology close behind at 32.4% and colorectal (11.8%), cardiothoracic (8.8%), and bariatric (2.9%) far lower. The ranking likely tracks time and infrastructure more than efficacy: orthopedic pathways have scheduled timelines, clear functional endpoints, and established rehab support, whereas oncologic urgency can compress the prehab window, so the concept normalizes most easily where surgery is planned early and physiotherapy, nutrition, and coordination are already in reach.
48.5% say clinical judgment during routine preoperative consultations is their primary method for identifying patients who need intensive optimization.
Clinical judgment during preoperative consultation dominates screening at 48.5%, far ahead of frailty scales (22.1%), physical performance tests (16.2%), nutritional screening (8.8%), and CPET (4.4%), so structured assessment exists but the surgeon’s own read remains the main gateway. That brings flexibility, judgment can weigh complexity, comorbidity, frailty, nutrition, and cancer urgency at once, but also variation, because a pathway that depends on individual recognition can miss patients when the referral trigger is not applied consistently.
35.3% identify lack of dedicated multidisciplinary staff as the single greatest barrier to routine prehabilitation in elective surgical workflow.
47.1% focus exclusively on medical optimization when cancer or urgent surgical timelines leave only 2–3 weeks before surgery.
With only two to three weeks, 47.1% focus exclusively on medical optimization, while 23.5% proceed directly to surgery, 16.2% start an accelerated home regimen, 10.3% postpone by one to two weeks, and 2.9% use a rapid-access rehab center. The trade-off is clear: a short window favors interventions that act fast, iron or anemia management, smoking cessation, nutritional supplementation, and focused education, while exercise and broader conditioning are hard to deliver at meaningful intensity without a fast-start pathway, so the question is which components improve readiness without a delay that outweighs the benefit.
36.8% say only 25%–50% of surgical patients fully adhere to prescribed home-based prehabilitation, while 39.7% see remote patient monitoring as the digital tool with the greatest potential to improve participation.
Home adherence is the visible weak point, the most common band is just 25% to 50% (36.8%), with 32.4% at 51% to 75%, only 10.3% above 75%, 13.2% below 25%, and 7.4% not monitoring. On technology, remote patient monitoring with clinician check-ins leads at 39.7%, ahead of mobile apps (29.4%) and wearables (26.5%), and that preference is telling: surgeons want a digital layer that connects patients to a nurse or therapist rather than an automated reminder, which fits the survey’s core theme that prehab depends on coordination, not just content delivery.
The survey shows a field in transition. More than a third describe formal prehab as routine across major elective surgery, yet many still use it selectively, informally, or not at all. Surgeons see the most value in major orthopedic and complex oncologic procedures, but patient selection is still led by clinical judgment, and the strongest barrier is the multidisciplinary team needed to turn that judgment into an actionable plan.
The short pre-op window exposes the core tension: when surgery cannot wait, respondents compress prehab toward medical optimization and almost a quarter proceed directly, while modest home-program adherence helps explain why remote monitoring with clinician contact beats automated support. The path to universal prehab therefore looks less like a new exercise protocol and more like a perioperative operating model, needing reliable screening, referral triggers, staff, funding, home participation, data visibility, and specialty-specific rules for when optimization fits without compromising surgical timing.
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