Implementation of a prehabilitation program before abdominal wall surgery: a pilot and feasibility study.

Abstract

<h4>Purpose</h4>Prehabilitation in abdominal wall surgery (AWS) might improve postoperative outcomes, but current data are scant. A prehabilitation program before AWS, including specific hypopressive abdominal exercises, was recently implemented in our department. This study aimed to present the characteristics of the implemented program and to assess the adherence rate to hypopressive abdominal exercises.<h4>Methods</h4>A retrospective study of all consecutive patients included in the pathway from October 2021 to October 2024 was performed. The multimodal prehabilitation program included nutritional support, physical activities (cardiorespiratory training, muscular strengthening, hypopressive abdominal exercises, and relaxation), and psychological support. Adherence rate was defined as the number of patients who performed the proposed abdominal exercises divided by the total number of included patients.<h4>Results</h4>A total of 103 patients were included (43% women, median age: 64, IQR 55-72, median body-mass index: 29 kg/m², IQR 26-33). Most of them had a midline hernia (n = 79, 77%) and underwent a retromuscular mesh repair (n = 93, 90%). Ninety-six patients were adherent to the hypopressive abdominal exercises (adherence rate: 93%). Obese patients had a significantly lower adherence rate to hypopressive abdominal exercises than non-obese patients (29/34 = 85% vs. 67/69 = 97%, p = 0.025). Median length of hospital stay was 3 days (IQR 2-5) and postoperative complications occurred in 29 patients (28%).<h4>Conclusion</h4>The implementation of a prehabilitation program in AWS was feasible. Moreover, adherence to the hypopressive abdominal exercises was high. Obese patients might require more attention to improve their adherence to the program.