Short- and midterm outcomes of prehabilitation in abdominal wall surgery: a retrospective cohort study

Data concerning prehabilitation in abdominal wall surgery (AWS) remain scarce and controversial. This study aimed to compare the postoperative short- and midterm outcomes between patients with prehabilitation and those without prehabilitation before AWS.

All consecutive patients who underwent surgery for primary/incisional, midline/lateral, and parastomal hernias between October 2021 and October 2024 were retrospectively included. Patients who underwent prehabilitation (including nutritional support, psychological support, and physical preparation) were compared with those who did not undergo prehabilitation. The primary outcome was 30-day morbidity.

A total of 315 patients were included: 114 with prehabilitation and 201 without prehabilitation. Preoperative and intraoperative characteristics were similar in both groups, except for the higher botulinum toxin injection (BTI) rate (71/114 in the prehabilitation group vs 18/201 in the no-prehabilitation group; P <.001) and larger median hernia size (10 cm in the prehabilitation group vs 6 cm in the no-prehabilitation group; P <.001). There were no differences between both groups in complication rates (35/114 in the prehabilitation group vs 61/201 in the no-prehabilitation group; P =.948), major complications (15/114 in the prehabilitation group vs 28/201 in the no-prehabilitation group; P =.848), surgical site occurrences (23/114 in the prehabilitation group vs 40/201 in the no-prehabilitation group; P =.953), and median length of stay (3 days in the prehabilitation group vs 2 days in the no-prehabilitation group; P =.707). In contrast, the recurrence rate was lower in patients in the prehabilitation group than in those in the no-prehabilitation group (2/114 vs 14/201, respectively; P =.043; median follow-up: 16 months [95% CI, 15-17]). Among patients who received BTI, patients in the prehabilitation group had a lower complication rate than those in the no-prehabilitation group (20/71 vs 10/18, respectively; P =.028). Prehabilitation was independently associated with a decreased morbidity rate among patients who received BTI (odds ratio, 0.3 [95% CI, 0.1-0.9]; P =.027).

Prehabilitation did not decrease postoperative morbidity in the overall cohort but was associated with a lower midterm recurrence rate. In the BTI subgroup, patients in the prehabilitation group had less complications, suggesting a potential benefit of coupling BTI with a prehabilitation pathway.