Optimising Outcomes With Prehabilitation Before Major Abdominal Surgery: A Single-centre Prospective Study

Background and Aims: Prehabilitation aims to enhance a patient’s physiological reserve before surgery, thereby improving postoperative outcomes. Despite the adoption of Enhanced Recovery After Surgery protocols, complications remain prevalent following major abdominal procedures. This prospective observational study evaluates the impact of structured exercise and nutritional support on post-operative outcomes in patients undergoing major abdominal surgery. Patients and Methods: A total of 35 patients scheduled for elective major abdominal surgery at a tertiary centre were enrolled between December 2019 and September 2021. The prehabilitation program included individualised aerobic and resistance training, nutritional optimisation and psychological support. Functional capacity was assessed using the 6-minute walk test (6MWT) pre-operatively and 4 weeks post-operatively. Secondary outcomes included complications (Clavien-Dindo classification), length of hospital stay, readmissions, psychological status (HADS) and quality of life (Stark score). Results: The mean age was 58.9 years, with 54.3% male participants. Pulmonary complications occurred in 31.4%, with no mortality. Median HADS scores showed significant reductions in both anxiety ( P = .041) and depression ( P = .046). Quality of life improved post-operatively ( P = .032), and 6MWT values improved marginally without statistical significance ( P = .64). There was no significant difference in 6MWT based on ASA grade, gender or Clavien-Dindo class. Conclusion: A structured multimodal prehabilitation program incorporating physical, nutritional and psychological components is feasible and beneficial in improving mental well-being and preserving functional capacity post-surgery. Although differences in physical recovery were not statistically significant, prehabilitation appears to positively influence overall recovery and patient-reported outcomes. Further large-scale trials are warranted to confirm its efficacy and standardise protocols.