Preoperative pathways in adults with multiple long-term conditions undergoing major surgery: a systematic review

Adults with multiple long-term conditions (MLTCs) undergoing surgery have a higher risk of postoperative complications compared with adults without MLTCs. No preoperative care interventions, pathways or protocols exist to specifically support people with MLTCs. Our aims were to: (i) summarise current preoperative interventions targeted at people with MLTCs, (ii) report outcomes of preoperative interventions specifically designed for MLTC populations and (iii) identify future research into interventions resulting in better surgical outcomes for this population.

Systematic review was performed to identify studies reporting on preoperative interventions, pathways and protocols for adults with MLTCs undergoing surgery. Quality was evaluated using the Quality Assessment Tool for Quantitative Studies.

MEDLINE, Embase, Scopus, Web of Science Core Collection and CINAHL were searched from 1 January 2013 to 17 December 2025.

Two independent reviewers (NMN, SKK) used standardised methods to search and screen for included studies within the databases, and disagreements were resolved by the third reviewer (EH). The included full papers were retrieved, read and data extraction was undertaken independently by two reviewers (NMN, SKK).

Of 138 studies that identified adult cohorts with MLTCs undergoing major surgery, 34 were included. Findings included the following: (i) six (18%) studies discussed preoperative interventions for mixed cohorts of MLTC and non-MLTC patients, and (ii) three (9%) reported the use of preoperative interventions designed for the general surgical population on patients with MLTCs.

There is a paucity of data specifically pertaining to surgical interventions specifically identified for patients with MLTCs. The existing literature neither supports the existence of specific preoperative interventions nor the establishment of new interventions specifically designed for this population. However, this study found that several studies showed existing interventions designed for the general surgical population may improve outcomes for patients with MLTCs. The lack of heterogeneity regarding the definition of multimorbidity may result in an under-identification of surgical interventions designed for patients with MLTCs. We recommend future research should identify whether the current preoperative interventions, pathways and protocols developed for the general population are applicable to MLTC populations, or whether completely new actions need to be developed to cater to the specific complications of people with MLTCs.

CRD42023445506.