Optimizing Postoperative Outcomes in Gastrointestinal Surgery: An Integrated Approach to Prehabilitation, Perioperative Nutrition, Multimodal Analgesia, And Enhanced Recovery

Major gastrointestinal surgery remains associated with considerable postoperative morbidity, delayed functional recovery, and prolonged hospitalization, highlighting the need for integrated perioperative strategies. This narrative review aimed to analyze the clinical relevance of multimodal prehabilitation and Enhanced Recovery After Surgery (ERAS) protocols, emphasizing perioperative nutritional optimization, multimodal analgesia, and gastrointestinal functional recovery. A descriptive, analytical, and integrative approach was adopted to examine 20 scientific publications, including randomized controlled trials, systematic reviews, meta-analyses, and international clinical guidelines, with particular consideration of their applicability to Latin American healthcare settings. The reviewed evidence demonstrated heterogeneous but clinically relevant benefits associated with multimodal prehabilitation, including reductions in selected postoperative complications and improvements in functional recovery. Preoperative oral nutritional supplementation was associated with fewer infectious complications, whereas carbohydrate loading and early oral feeding demonstrated favorable outcomes regarding gastrointestinal recovery and hospitalization duration. Multimodal analgesic interventions, particularly intravenous lidocaine and transversus abdominis plane blocks, were associated with reduced early postoperative pain and opioid consumption. Improvements in gastrointestinal recovery were reflected in shorter times to bowel sounds, first flatus, and first defecation, although these findings did not consistently establish reductions in clinically defined postoperative ileus. Variability in patient characteristics, surgical procedures, intervention protocols, and institutional resources limited direct comparisons between studies. The findings support a coordinated, multidisciplinary, and patient-centered approach to perioperative management. Further research is necessary to determine optimal intervention combinations, standardize recovery outcomes, and evaluate the effectiveness and feasibility of integrated ERAS pathways across diverse healthcare systems, particularly in Latin America.