Pre-surgery exercise and nutrition sharply cut complications, hospital stays

A few weeks of exercise, nutrition support and, in some programs, psychological preparation before surgery sharply improved recovery in a new review that found postoperative complications fell by 48 percent overall and hospital stays dropped by 11 percent.

The review, published April 29, 2026, in the Journal of the American College of Surgeons, analyzed 23 randomized controlled trials involving more than 2,100 patients. The American College of Surgeons said outcomes were tracked for complications within 12 weeks after surgery, a window that captures the infections, setbacks and delays that can turn an operation into a much longer medical ordeal.

The strongest effect came from exercise-based prehabilitation. Patients in those programs were 55 percent less likely to suffer complications than patients receiving standard care. Nutrition-focused programs did not lower complication rates, but they were linked to shorter hospital stays, suggesting that different parts of prehabilitation may work through different pathways. Exercise programs in the review lasted from two weeks to six months, and about 67 percent were supervised by clinical teams while 33 percent were unsupervised and monitored with logbooks. Nutrition programs typically lasted five days to two weeks.

Justine Lee, associate chief of plastic and reconstructive surgery at the UCLA David Geffen School of Medicine in Los Angeles, said the findings support the value of prehabilitation for optimizing health before surgery and for helping high-risk patients who may need extra support. That is the real implementation gap: the evidence now points toward surgery as a process that begins well before the operating room, but many hospitals still organize care as if pre-op preparation were optional rather than a core clinical step.

Turning that evidence into routine care would require changes from several sides. Hospitals would need to build supervised exercise, nutrition screening and follow-up into pre-op pathways. Insurers would need to reimburse those services instead of treating them as extras. Patients, especially older adults and people with chronic disease, would need access to transportation, coaching and enough time before surgery to complete the program. Without those pieces, the benefit may remain easiest to capture for people who are already healthier and most able to participate.

The stakes are not small. A 2024 British Journal of Surgery review described prehabilitation as tertiary prevention, aimed at preventing treatment-related complications, and noted that complications can consume up to 30 percent of the budget allocated to colorectal surgery. Yet broader evidence has also been mixed: a March 2026 stepped-wedge study at Radboudumc in Nijmegen found no overall reduction in complications or length of stay from hospital-wide multimodal prehabilitation, even as other reviews found isolated exercise and nutrition approaches most likely to help. That is why the field is also trying to standardize how studies are reported, with the SOS-Prehab consensus statement setting out a 40-item checklist to make surgical prehabilitation more reproducible and easier to compare.