Exploring the barriers to prehabilitation integration in Austrian healthcare: a qualitative analysis

Prehabilitation optimises patients' physical, nutritional, and psychological readiness before major surgery, but remains largely absent from Austrian clinical practice. We aimed to identify stakeholder-perceived barriers to prehabilitation implementation and assess the readiness of the healthcare system.

An exploratory qualitative study using semi-structured interviews was conducted with eight purposively sampled stakeholders representing anaesthesiology (n=2), surgery (n=2), outpatient cardiology (n=1), clinical psychology (n=1), physiotherapy (n=1), and health insurance administration (n=1). Interviews conducted between February and March 2024 were analysed using descriptive thematic content analysis and mapped to the Consolidated Framework for Implementation Research.

Six themes emerged: attitudes towards prehabilitation, work environment, healthcare system structure, economic factors, cultural factors, and politics, evidence, and guidelines. Despite unanimous recognition of clinical value, knowledge of prehabilitation varied widely. Critical barriers included the structural and financial separation between inpatient and outpatient sectors, the absence of reimbursement mechanisms, workforce shortages, organisational inertia, and limited advocacy by professional societies. Consolidated Framework for Implementation Research mapping identified barriers across all five domains, with outer setting barriers-particularly fragmented financing and the absence of national guidelines-being the most prominent.

These exploratory findings reveal conceptual, systemic, and cultural barriers to prehabilitation in Austria. The simultaneous absence of integrated financing, professional society advocacy, and coordinated governance may explain Austria's particularly limited uptake compared to that in the UK and the Netherlands. These findings are hypothesis-generating and require validation through larger-scale qualitative studies, quantitative surveys, and pilot implementation trials that include patient perspectives and economic modelling.