Surgeon perspectives on prehabilitation in Abdominal Wall Reconstruction (AWR): a multi-institution survey

Prehabilitation, including smoking cessation, weight loss, and glycemic control, has been shown to improve outcomes in abdominal wall reconstruction (AWR). While many AWR programs have adopted these strategies, it remains unclear how consistently general surgeons (GS) implement prehabilitation in elective AWR.

An 18-question anonymous survey was distributed via REDCap to GS at two tertiary care institutions with active AWR programs. Surgeons who performed hernia repair but were not members of the AWR programs were questioned. Descriptive statistics compared attitudes, practices, and institutional support across hospitals by surgical volume were performed.

Surveys were sent to 57 GS at Hospital System 1 (HS1) and 27 GS at Hospital System 2 (HS2). Of 84 surveys, 28 GS responded, yielding response rates of 30% for HS1, 48% for HS2, and 33% overall. All respondents agreed that active smoking, obesity, and uncontrolled diabetes negatively impact AWR outcomes. However, less than one-third postpone surgery for smoking cessation (32%), weight loss (29%), HbA1C improvement (32%). Barriers included concern about surgical volume/income (25%), limited perceived support from colleagues (43%) or their institution (53%). Although 57% reported access to prehabilitation resources, only 13% consistently referred patients.

Despite strong evidence, unanimous agreement of its benefits, and active, institutional AWR programs that perform prehabilitation, this practice remains underutilized among general surgeons. Concerns about reduced operative volume, income, and colleague and institutional support are key barriers. Addressing these may increase prehabilitation utilization among GS and ultimately improve outcomes.