Multimodal prehabilitation didn’t significantly reduce complications or hospital stays for elective surgery patients, suggesting a need for focused patient selection.

• Among 4,131 patients, no difference in complications (adjusted risk ratio 1.02) or hospital stay (adjusted ratio 1.04) was found between standard care and prehabilitation.
• In high-risk gastrointestinal surgery patients, complication risk was 9% lower but not statistically significant (adjusted risk ratio 0.91).

Consider targeting high-risk patients for prehabilitation to better assess its effectiveness in improving surgical outcomes.