A total of 1584 studies were retrieved, the screening flow chart was shown in Supplementary Figure S1. After being assessed by full text, 638 articles on the prehabilitation of surgical patients were included, including 427 articles and 211 reviews. Among them, 621 articles (97.3%) were published in English, 11 in German, 3 in French and 3 in Spanish.

Figure 1 illustrated the number and trend of the annual publications on prehabilitation of surgical patients from 2005 to 2023. According to the trend, the progress of this field could be roughly divided into three stages: (1) From 2005 to 2012, the number of publications each year was less than 5, indicating that research in this field was in its infancy and had not received attention. (2) From 2013 to 2015, the annual number of publications was slightly higher than before, approximately 10 per year, which formed the second platform period. (3) From 2016 to 2022, the number of articles increased exponentially at an average rate of 41.0%, from 21 articles in 2016 to 125 articles in 2022.

Annual publication counts on prehabilitation of surgical patients during 2005–2023

Figure 2A showed the distribution of publications over time for the top 15 countries. Denmark, the USA, and Ireland were among the first countries to conduct prehabilitation studies. The UK and Canada joined them later. However overall, enthusiasm was low in the early stage. Since 2016, especially in the past 3 years, many studies have been conducted by various countries, and prehabilitation has attracted the attention of the global medical community. Countries in North America and Europe led the world in the number of publications in this field (Fig. 2B). Scholars from the United States published the most articles (128 publications), followed by the UK (122 publications), Canada (114 publications), and the Netherlands (82 publications). Publications from other countries were less than 50. Among the top 20 countries with most publications, there was a very close collaboration between them. Cooperation between countries was represented by lines and thicker lines indicate more frequent collaboration (Supplementary Figure S2). Most of the cooperation occurred between European and American countries, with the largest cooperation frequency between Canada and the USA, followed by Canada and Italy, the UK and Australia, and the UK and the USA.

A Distribution of publications over time for the top 15 countries with most publications. B World map of publication counts

A total of 926 institutions contributed to the study of prehabilitation. Figure 3A showed that the 10 most productive institutions came from Canada, the UK, the Netherlands, the USA, Australia, and Spain. In the overlay network of co-authorship analysis of the top 50 institutions, the size of the node reflected the number of publications by institution, The lines between nodes illustrated the collaboration between different institutions, and the colors indicated the average commencement year of publications for each institution (Fig. 3B). Researchers at the University of Toronto, the Princess Margaret Cancer Centre, and the University of Liverpool were pioneers in the field of prehabilitation. In contrast, researchers at Erasmus University and University College London have conducted more recent studies in this field.

A Top 10 productive institutions. B Overlay network of co-authorship analysis of the top 50 institutions

A total of 3348 authors published articles on the prehabilitation of surgical patients. Table 1 lists the top 10 authors in terms of publications. Francesco Carli was the most productive author, who had published 67 articles. The G-index is an index obtained by a comprehensive consideration of the number of publications and the citation frequency of articles, which can more accurately reflect the influence of an author in a specific field. The higher the index, the greater the influence of the author. Francesco Carli, Chelsia Gillis, Rashami Awasthi, and Enrico M. Minnella from McGill University are the four scholars with the highest G-index. In the density map drawn based on the number of publications of the authors (Supplementary Figure S3), the deeper the color, the more publications the author has. A productive collaborative group was formed around the above four high-impact authors.

A total of 263 journals published articles on the prehabilitation of surgical patients. Table 2 shows the top 10 journals with the most publications and their impact factors. Half of the top 10 journals came from the UK and four came from the USA, mainly in the fields of surgery, anesthesiology, and oncology. Journal Citation Reports (JCR) could reflect the quality and professional influence of journals. All of the top 10 journals were classified into JCR-Q1 or Q2, indicating that prehabilitation of surgical patients was a topic worthy of discussion.

Exploring the occurrence frequency of keywords and co-occurrence analysis can quickly focus on research hotspots and reflect the changing trend of research hotspots. Out of 1742 keywords, the lowest frequency limit of occurrence was set to 16 according to Price’s law. A total of 72 keywords were included in the analysis. “Prehabilitation” was the most frequently used keyword (frequency = 428), followed by “exercise” (frequency = 286) and “surgery” (frequency = 207). “Colorectal cancer”, “colorectal surgery” and “abdominal surgery” exhibited a notably higher frequency than other diseases and types of surgery, indicating that many prehabilitation-related studies had been carried out in such patients. Figure 4A showed the results of the cluster analysis generated by VOSviewer. The size of the node reflected the frequency of the keyword, while the line between the two nodes reflected the co-occurrence. All keywords were grouped into 3 clusters that roughly reflect the main themes in the research field. The red cluster mainly focused on the terms “prehabilitation”, “ERAS” and “complication”. The green cluster focused on surgical-related conditions, which included “surgery”, “colorectal cancer”, and “morbidity”. The main keywords in the blue cluster were “rehabilitation”, “outcomes”, and “quality of life”. In addition, terms related to “exercise” were included in the blue cluster. In general, the most prominent nodes in Fig. 4A summarized the connotation of prehabilitation: implementation before surgical procedures with the purpose of improving postoperative recovery and outcomes of the patients. The overlay visualization of keywords and average time of appearance showed the changes in research hotspots over time and pointed out the research trends in the future. In Fig. 4B, keywords appearing earlier were shown in blue, while orange represented keywords appearing more recently. “Total knee arthroplasty”, “osteoarthritis”, and “physical therapy” were topics of early attention. In contrast, “malnutrition”, “older patients”, “frailty”, and “high-risk patients” have recently received considerable attention from researchers in the field.

A Network visualization of keywords. B Overlay network of keywords

Co-citation analysis is a valuable method for assessing the most cited articles. Local citation frequency is used to reflect the impact of articles in a particular research field. The top three cited journals were Annals of Surgery (926 co-citations), British Journal of Surgery (574 co-citations), and British Journal of Anaesthesia (556 co-citations). Furthermore, a co-citation analysis of references was carried out. The minimum number of citations was set as 35. A total of 49 studies were obtained to draw the co-citation map (Fig. 5). More than 70% of the articles in the green cluster were published before 2010, representing the early development stage of this field. Most studies in the green cluster focused on orthopedic surgery, from which we could learn the origin of the concept of prehabilitation (Topp et al. 2002; Carli and Zavorsky 2005). The literature in the red cluster was published from 2010 to 2017, and the research subject was transferred to abdominal surgery, especially colorectal cancer surgery. The blue cluster was the articles published in the last 5 years. Fifty percent of the articles were meta-analyses and systematic reviews, which comprehensively summarized the conclusions of previous studies and provided more reliable clinical evidence. The others were clinical studies with a shift in content, which focused on elderly, frail patients, patient adherence, and patient-reported outcomes (PROs). Among the top 10 cited articles, 1 article was published in 2018. The remaining 9 articles were all published before 2016, including 6 clinical trials, 2 meta-analyses, and 1 review (Supplementary Table S1). To account for the effect of publication time on citations, we also counted the top 10 cited articles on average annual citations (Supplementary Table S2). The 2 articles were duplicated with Supplementary Table S1 and 8 new articles published from 2018 to 2022 were additionally retrieved.

Co-citation network of references