Prehabilitation: Are There Sex- and Gender-Specific Issues in Surgery Preparation?

Prehabilitation programs have advanced considerably; however, critical issues related to sex- and gender-specific factors remain largely unaddressed. Historically, research has been male-centered due to the underrepresentation of females in clinical trials, often attributed to concerns over hormonal variability. This focus has resulted in significant knowledge gaps and potential biases that impact effectiveness across sexes. We aim to highlight the need for integrating sex- and gender-specific considerations into prehabilitation to optimize surgical outcomes and promote equitable care for all patients.

Both biological (sex-related) factors, such as differences in muscle mass, metabolism, and body composition, and social (gender-related) factors, such as caregiving roles and stress management, influence individuals' responses to presurgical preparation. A review of the existing literature reveals a scarcity of data on sex and gender differences in prehabilitation, highlighting a major barrier to designing equitable and effective programs. Evidence underscores that comprehensive prehabilitation approaches, integrating physical, nutritional, and psychological elements, must account for these differences to optimize recovery outcomes.

Sex- and gender-specific factors significantly shape patients' responses to prehabilitation and should be systematically incorporated into program design. The current lack of research on these differences limits the effectiveness of prehabilitation strategies, emphasizing the need for focused investigations. Addressing these gaps will facilitate the development of tailored, equitable prehabilitation programs that enhance presurgical care and improve recovery outcomes for all patients.