Optimizing Surgical Outcomes Through Multimodal Prehabilitation: The Role of Nutrition, Exercise, and Functional Conditioning Before Major Abdominal Surgery

Major abdominal surgery remains associated with substantial postoperative morbidity, functional deterioration, and prolonged recovery despite advances in surgical techniques, anesthesia, and perioperative care. Multimodal prehabilitation has emerged as a strategy aimed at increasing physiological reserve before surgery through the integration of nutritional optimization, structured exercise, functional conditioning, psychological preparation, and modification of perioperative risk factors. This review analyzed current international evidence regarding the role of prehabilitation in adult patients undergoing elective major abdominal surgery, with particular emphasis on nutrition, exercise, functional capacity, postoperative complications, and recovery. Evidence from systematic reviews, meta-analyses, randomized clinical trials, clinical guidelines, and international consensus documents indicates that structured exercise and nutritional optimization constitute the most consistently incorporated components of prehabilitation programs. Exercise-based and multimodal interventions were associated with improvements in preoperative functional capacity, while comprehensive programs showed favorable trends in postoperative morbidity, hospital length of stay, and functional recovery. High adherence, professional supervision, early nutritional intervention, individualized risk assessment, and integration with Enhanced Recovery After Surgery pathways were identified as important factors associated with successful implementation. Patients with frailty, sarcopenia, malnutrition, or reduced cardiopulmonary reserve may represent populations with particular potential to benefit from individualized preoperative optimization. Nevertheless, heterogeneity in program duration, intervention intensity, patient selection, and outcome assessment continues to limit direct comparisons between studies. Current evidence supports multimodal prehabilitation as a relevant component of contemporary perioperative medicine and emphasizes the need for standardized, accessible, and patient-centered strategies that can be adapted to different healthcare systems, including Latin American settings.