Impact of a Multimodal Prehabilitation Program on Perioperative Outcomes in Hepatopancreatobiliary Surgery: A Retrospective Cohort Study.

Background: Major hepatopancreatobiliary (HPB) surgeries cause significant physical stress. In this study, we evaluated how a 4-week multimodal prehabilitation program affects perioperative outcomes across different types of HPB procedures. Methods: We conducted a retrospective cohort study of 359 patients undergoing HPB surgery (162 historical controls and 197 in the prehabilitation group). To accurately assess the clinical benefits of various procedures, patients were stratified into specific surgical groups: major and minor hepatectomy, pancreatoduodenectomy (PD), and left pancreatectomy (LP). Results: The prehabilitation program significantly improved preoperative nutrition, demonstrated by increased serum albumin levels on the day of surgery (p < 0.001), and the clinical benefits were most pronounced in pancreatic surgeries. Patients undergoing PD in the prehabilitation group had a significantly shorter median hospital stay (8 versus 13 days, p < 0.001). LP patients also experienced shorter hospital stays (5 versus 9 days, p = 0.001) and reduced blood loss (p = 0.002). For minor hepatectomies, the intervention significantly lowered the need for blood transfusions (8.3% versus 18.9%, p = 0.033). The length of stay and complication rates for major hepatectomies remained comparable between groups. Importantly, major morbidities and 90-day mortality were low and similar across all cohorts. Conclusions: Multimodal prehabilitation successfully optimizes preoperative nutrition and accelerates hospital discharge, especially after highly stressful pancreatic surgeries. Because benefits vary by surgical magnitude, prehabilitation pathways should be tailored to prioritize high-risk patients facing complex operations.