Prevalence of poor functional capacity in patients undergoing prehabilitation before major surgery: A systematic...

Prehabilitation aims to enhance physiological reserve prior to major surgery; however, the proportion of patients with impaired functional capacity who actually receive these interventions remains unclear. Identifying this subgroup is crucial, as patients with reduced functional capacity are those most likely to benefit from prehabilitation. This systematic review and meta-analysis aimed to estimate the prevalence of poor functional capacity among adult patients undergoing prehabilitation before major surgery.

A systematic review was conducted according to PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251026613). MEDLINE, Embase, Scopus, Web of Science, SciELO, and Biblioteca Virtual de Salud were searched from inception to September 2025. Studies including adults undergoing prehabilitation prior to major surgery with reported functional capacity data were eligible. Risk of bias was assessed using the Joanna Briggs Institute checklist for prevalence studies. A random-effects meta-analysis was performed to estimate pooled prevalence, with heterogeneity explored through subgroup, sensitivity, and meta-regression analyses.

Seven studies comprising 306 participants were included. Functional capacity was assessed with cardiopulmonary exercise testing in four studies and the six-minute walk test in three. The pooled prevalence of poor functional capacity among patients undergoing prehabilitation was 36% (95% CI: 27-46%), with substantial heterogeneity (I²=63%). A higher prevalence was observed in patients undergoing oncological surgery (41%; 95% CI: 30-53%) than in those undergoing non-oncological surgery (23%; 95% CI: 13-35%). Sensitivity analyses confirmed the robustness of the findings.

More than one-third of patients receiving prehabilitation before major surgery have poor functional capacity, though considerable variability exists across studies. Standardized, systematic assessment of functional capacity may improve identification of high-risk patients and optimize the targeting and effectiveness of prehabilitation programs in perioperative care.