Advancing pharmacist involvement in surgical prehabilitation: a call to action for global pharmacy practice

Prehabilitation has emerged as a proactive, multimodal strategy in perioperative care, aiming to enhance functional capacity and resilience before surgery through medical optimization, exercise, nutrition, and psychological support. Despite their multidisciplinary nature, pharmacists are underutilized in this evolving field. Pharmacists are uniquely positioned to advance prehabilitation by applying Medication Therapy Management (MTM) and Collaborative Drug Therapy Management (CDTM) models to identify medication-related risks, manage comorbidities, and optimize perioperative outcomes. China's experience provides a compelling demonstration of this potential. Since 2015, Zhihua Zheng and colleagues at the Guangdong Pharmaceutical Association have pioneered surgical pharmacy, integrating MTM into pharmacist-managed clinics and employing CDTM frameworks to extend pharmacists' clinical authority in China. These innovations empower pharmacists to perform key prehabilitation functions, such as optimizing complex medication regimens, mitigating polypharmacy, stabilizing cardiovascular and metabolic parameters, managing nutrition and anemia, and supporting pain control. Internationally, prehabilitation has gained traction through initiatives such as Enhanced Recovery After Surgery programs and perioperative surgical home models. However, the pharmacist's contribution remains insufficiently defined. This commentary aims to highlight strategic opportunities for strengthening pharmacist involvement in prehabilitation rather than prescribing detailed operational protocols. Integrating MTM and CDTM conceptually within prehabilitation teams offers a scalable, evidence-informed direction that can guide health systems to enhance perioperative safety and readiness. Pharmacist-led interventions not only reduce medication errors and adverse events but also complement the work of surgeons, anesthesiologists, nutritionists, and rehabilitation specialists. Global collaboration is essential for standardizing competencies, developing training frameworks, and strengthening the evidence for pharmacist-led prehabilitation. The International Pharmaceutical Federation (FIP), the American Society of Health-System Pharmacists (ASHP), and the European Society of Clinical Pharmacy can catalyze this progress by promoting education, guidelines, and policy integration. By embedding MTM/CDTM into surgical prehabilitation, health systems can empower pharmacists to enhance patient safety, improve surgical outcomes, and advance the global standards of perioperative care.