Surgery and multiple chronic conditions: preoperative pathways remain understudied

A review focused on preparation before major surgery

The researchers examined preoperative interventions, pathways and protocols for adults with multiple chronic conditions who were scheduled to undergo major surgery. Their aim was to determine which approaches had been studied for this population and what outcomes had been reported.

The literature search covered five bibliographic databases, spanning January 1, 2013, to December 17, 2025. Of 138 studies that identified surgical cohorts including these patients, 34 were included. Study selection and data extraction were performed independently by two reviewers, with a third consulted in cases of disagreement.

General interventions, but little population-specific data

Among the included studies, six described preoperative interventions in groups combining patients with and without multiple chronic conditions. Three reported the use of interventions designed for the general surgical population in patients with multiple chronic conditions.

According to the authors, several studies suggest that these general interventions could improve outcomes for these patients. However, the abstract does not specify the interventions involved, the comparators or the absolute effects. It therefore does not allow a preferred approach to be identified.

A lack of evidence, not evidence of ineffectiveness

The distinction matters: this review primarily identifies a shortage of targeted research. It does not demonstrate that existing preoperative care is ineffective, or that every patient with multiple chronic conditions needs an entirely new pathway.

The next question is whether pathways already used in surgery are sufficiently adapted to this population or whether specific interventions would provide additional benefit. The authors call for research to distinguish between these possibilities. At this stage, the available information does not justify any individual preparation protocol.

What we can take away

The preoperative needs of adults living with multiple chronic conditions remain insufficiently documented. The value of specifically tailored pathways still needs to be evaluated.