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

Background: Hepato-pancreato-biliary (HPB) surgeries carry high risks of postoperative complications. This study evaluates the impact of a multimodal prehabilitation program on perioperative outcomes in patients undergoing hepatectomy and pancreatectomy. Methods: We conducted a retrospective cohort study at Phramongkutklao Hospital involving patients operated on between 2020 and 2023. Patients were divided into a Prehabilitation group (2022–2023, n=197), who underwent a 4-week program of exercise, nutritional support, and psychological counseling, and a historical Control group (2020–2021, n=162). Primary outcomes were postoperative complications and 30-day mortality. Results: The Prehabilitation group showed significantly improved preoperative serum albumin levels compared to controls (p < 0.001). Intraoperatively, the Prehabilitation group had significantly shorter operative times (300 vs. 310 min, p=0.037) and reduced blood loss (400 vs. 500 ml, p=0.002). Postoperatively, the Prehabilitation group exhibited a significantly shorter length of hospital stay (median 6 vs. 9 days, p < 0.001) and lower overall morbidity (p < 0.001). No significant difference was observed in 30-day mortality. Conclusions: Multimodal prehabilitation effectively reduces hospital stay, blood loss, and postoperative complications in HPB surgery, supporting its implementation to optimize surgical recovery.