Prehabilitation as a litmus test for surgery in frail nonagenarians: a case series.

[BACKGROUND] As more older adults undergo major elective surgery, frailty increases their risk of complications. Prehabilitation, which often combines nutrition, exercise, and psychosocial support, may benefit these patients by improving their physiological reserve and increasing their resilience for recovery. However, representation of very old adults in prehabilitation research is scarce.

[CASE PRESENTATION] This case series presents the unique experiences of five nonagenarians who participated in prehabilitation prior to major elective surgery for colorectal cancer. Two patients received nutrition-only interventions, two received combined nutrition and exercise interventions, and one received exercise alone. Two patients who improved in both preoperative nutritional and functional status experienced favourable perioperative outcomes. In contrast, three patients demonstrated a decline in functional status accompanied by postoperative complications; one of these patients also experienced a decline in nutritional status and subsequently died.

[CONCLUSION] We highlight that, among nonagenarians with frailty, prehabilitation performance may be associated with postoperative outcomes, suggesting that responsiveness to prehabilitation may serve as a pragmatic indicator of surgical readiness. Prehabilitation provides an opportunity to assess physiological reserve and guide shared decision-making regarding surgical candidacy and perioperative care intensity.