Prehabilitation in metabolic and bariatric surgery: a narrative review

Background and Objective: With over 250,000 metabolic and bariatric surgeries performed in the United States annually, there has been an interest in minimizing preoperative surgical risk and thus optimizing surgical outcomes. One of the recent strategies to accomplish this is by instituting prehabilitation, defined as a preoperative program with the goal of improving functional capability and consequently, postoperative outcomes. Improved outcomes have been associated with prehabilitation in other surgical subspecialties, such as cardiovascular and orthopedics. However, the role of prehabilitation within metabolic and bariatric surgery remains unclear. In this review, we aim to present and summarize the available literature surrounding prehabilitation, as well as discuss its implications and clinical practicality. Methods: A literature search was conducted using PubMed/MEDLINE and OVID databases, as well as Google Scholar, to identify relevant articles on prehabilitation in bariatric and metabolic surgery. Studies published until June 28, 2022, were considered. Key Content and Findings: The structure and timeframe of prehabilitation programs, as well as the measurement of targeted outcomes, are highly variable in current literature. Although prehabilitation may benefit select bariatric patients by increasing cardiopulmonary fitness, improving quality of life, or inducing favorable physiological changes, there are conflicting or inadequate data, likely due to the heterogeneity of the programs. High-risk patients are commonly excluded from these studies, although they may benefit the most from prehabilitation. Conclusions: A formal recommendation has yet to be made regarding which patients should undergo prehabilitation, as well as the optimal and timing of the intervention. Future studies should provide a standardized definition of prehabilitation, extend the follow-up period, and expand the patient population to include high-risk individuals.