Perioperative Optimization in High-Risk Surgical Patients: A Scoping Review of Nutrition, Prehabilitation, and Strategies for Complication Prevention

Vollständiger Abstract

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High-risk surgical patients, particularly those with frailty, sarcopenia, malnutrition, multimorbidity, and impaired functional or cardiopulmonary reserve, experience disproportionately high rates of postoperative morbidity and functional decline. Increasing attention has therefore focused on perioperative optimization and prehabilitation as strategies to improve physiological reserve and reduce adverse surgical outcomes. This scoping review aimed to map and synthesize contemporary evidence on nutritional optimization, prehabilitation, and complication-prevention strategies among high-risk adult surgical patients, with emphasis on clinical, functional, nutritional, patient-centered, and implementation outcomes. Following JBI guidance and the PRISMA-ScR framework, literature published between January 2016 and August 2026 was reviewed using the Population, Concept, and Context framework. PubMed-indexed literature and Sci Space were searched, supplemented by citation searching. Eligible studies included randomized trials, comparative studies, cohort studies, and feasibility or implementation studies involving adults with explicitly defined elevated perioperative risk. Data were synthesized descriptively because of substantial clinical and methodological heterogeneity. Across 18 primary studies involving approximately 2,855 participants, exercise was incorporated into all optimization programs, whereas nutritional, respiratory, psychological, behavioral, and medical or geriatric components were included to varying degrees. Improvements in functional capacity, nutritional status, muscle strength, and physiological reserve were reported with relatively consistent frequency. Reductions in postoperative complications were observed particularly among patients with impaired cardiopulmonary fitness, sarcopenia, nutritional vulnerability, and selected frail gastrointestinal surgical populations. However, several large frailty-focused randomized trials demonstrated neutral overall clinical effects. Adherence was generally higher in structured, supervised programs, whereas short preoperative intervals, transportation difficulties, and competing priorities limited implementation. Perioperative optimization appears feasible and beneficial for improving physiological and functional reserve in high-risk surgical patients. Greater clinical benefit may be achieved through individualized, phenotype-directed multimodal prehabilitation rather than reliance on frailty status alone.