Why 90% of Surgical Patients Miss Out on Prehabilitation

The evidence for prehabilitation is compelling, consistent and growing. Structured pre-operative preparation reduces complications, shortens hospital stays and accelerates functional recovery across every major surgical specialty. Yet the vast majority of surgical patients never receive it. This post examines why that gap exists, what it costs patients and health systems, and what closing it actually requires.

The Evidence is Clear. The Access is Not.

Prehabilitation is not an emerging intervention awaiting further validation. According to a systematic review published in the British Journal of Anaesthesia, multimodal prehabilitation programmes are associated with a 64% reduction in postoperative complications compared to standard care. Studies across colorectal, cardiac and orthopaedic surgery consistently show reductions in length of stay of between two and four days. The clinical case is established. The problem is not the evidence. The problem is delivery.

Estimates vary, but surveys of surgical practice in the UK and comparable health systems consistently suggest that fewer than 10% of surgical patients have access to a structured prehabilitation programme before their operation. The majority of patients who could benefit from prehabilitation arrive at surgery having received no structured preparation at all. They have not been assessed, coached, supported or given a programme to follow. Surgery happens to them in whatever condition life has left them in.

This is not a failure of clinical intention. Most surgeons, anaesthetists and perioperative nurses understand the value of pre-operative preparation. The failure is structural. Prehabilitation as it has historically been delivered requires specialist physiotherapy teams, face-to-face supervision, hospital-based infrastructure and significant clinical time per patient. Those resources are finite, unevenly distributed and already under pressure. Without a fundamentally different delivery model, access cannot scale.

Why Traditional Delivery Models Cannot Scale

Conventional prehabilitation programmes are designed around a model of supervised, in-person delivery. A patient receives a referral, attends an assessment appointment, is allocated to a physiotherapist or exercise specialist, and follows a programme with regular face-to-face check-ins. In well-resourced settings, this works well. The evidence that underpins prehabilitation was largely generated in exactly these settings.

The problem is that well-resourced settings are not where most patients are. A patient at a major teaching hospital in a city centre may have access to a dedicated prehabilitation clinic with a multidisciplinary team. A patient at a district general hospital in a smaller town is unlikely to have access to anything comparable. A patient in a rural area may face travel times that make regular attendance practically impossible, regardless of clinical need. The health literacy requirements of navigating a complex referral pathway further disadvantage patients from lower socioeconomic backgrounds, who are also disproportionately likely to present with higher surgical risk.

Workforce constraints compound the problem significantly. NHS physiotherapy services are operating under sustained demand pressure, with waiting lists that frequently extend beyond the pre-operative window available for prehabilitation. Even where the clinical will exists to deliver prehabilitation at scale, there are simply not enough therapists, clinic slots or supervised sessions to reach the volume of patients who need it. A model that requires one-to-one clinical contact for every patient it serves cannot bridge a gap of this magnitude.

What the Access Gap Costs

The consequences of under-delivered prehabilitation are not abstract. Every patient who arrives at surgery without adequate preparation is at higher risk of complications than they would otherwise have been. Every complication extends a hospital stay, consumes clinical resource, delays recovery and reduces the quality of life outcomes the patient experiences. Aggregated across millions of surgical episodes annually, the cost of the access gap is enormous.

According to NHS England data, the average cost of a postoperative complication ranges from several thousand to tens of thousands of pounds depending on severity and procedure type. Against those figures, the cost of delivering a structured prehabilitation programme is modest. The return on investment is straightforward to calculate when the numbers are laid out honestly, and commissioners operating under value-based care frameworks are increasingly being asked to make exactly that calculation.

The prehabilitation access gap is not a clinical problem. It is a delivery problem, and it is one that technology is now positioned to solve.

Beyond the economic argument, there is a health equity argument that deserves equal weight. Access to prehabilitation currently correlates with geography, institutional resource and socioeconomic status. Patients who are already at higher surgical risk due to frailty, comorbidities or malnutrition are also the patients least likely to access the preparation that would most benefit them. That is an inequity with real clinical consequences, and it will not resolve itself through incremental improvements to existing delivery models. For a detailed look at what those consequences look like in practice, our post on the evidence behind prehabilitation sets out the full picture.

What Closing the Gap Actually Requires

Bridging the prehabilitation access gap requires a delivery model that does not depend on face-to-face clinical contact for every patient interaction. It requires a model that can reach patients wherever they are, adapt to their individual baseline and risk profile, monitor their progress without requiring a clinic appointment, and maintain engagement across a pre-operative window that may be short and unpredictable.

Digital health platforms are the only delivery model currently available that meets all of these criteria simultaneously. A well-designed digital prehabilitation platform can reach a patient in a rural community as effectively as one in a city centre. It can deliver a personalised, multimodal prehabilitation programme across movement, nutrition and mindset without requiring a physiotherapy referral for every interaction. It can monitor adherence, adapt programming in real time and flag deterioration or disengagement to the clinical team. It can scale to population level without a proportional increase in clinical resource.

This does not mean replacing clinical relationships. The most effective models use technology to extend the reach of clinical teams, handling the high-volume, high-frequency interactions that determine whether a patient completes their programme, while reserving face-to-face clinical time for assessment, escalation and complex cases. That combination preserves clinical quality while dramatically expanding access. Our post on how Clovo scales prehabilitation across entire patient populations examines the operational model in detail.

How Clovo Can Help

Clovo was built specifically to close the prehabilitation access gap. CEO Rory Skinner co-founded the company after identifying that the structural barriers to prehabilitation delivery were not going to be resolved by incremental improvements to existing clinical pathways. Together with CMO Dr Rebecca Hughes MRCS and CTO Dr Matthew Higgs-McCallum, the founding team built a platform designed from the ground up to deliver evidence-based, multimodal prehabilitation to every surgical patient who needs it, regardless of where they live or what hospital they attend.

Amy, Clovo’s AI recovery coach, delivers personalised prehabilitation programmes across movement, nutrition and mindset from the point of surgical listing. Amy adapts to each patient’s baseline, monitors engagement and progress in real time, and provides the consistent, responsive support that determines whether patients actually complete their preparation rather than simply being enrolled in a programme. For health systems and commissioners looking to understand how Clovo integrates with existing NHS pathways, our post on Clovo and NHS integration covers the practical detail.

The prehabilitation access gap is large, well-documented and entirely addressable. The evidence that justifies closing it is already there. What has been missing is a delivery model capable of reaching patients at the scale the problem demands. That model now exists, and the question for health systems is no longer whether to act on the evidence but how quickly they can build the infrastructure to do so.