Association between sarcopenia and functional outcomes in patients undergoing abdominal surgery: An integrative review

INTRODUCTION: Sarcopenia is a condition characterized by a progressive reduction in muscle strength and mass, which may compromise functional capacity and increase the vulnerability of patients undergoing surgical procedures. In the context of abdominal surgery, the presence of sarcopenia may be associated with a higher risk of postoperative complications, slower functional recovery, prolonged hospitalization, and a worse clinical course. In addition, surgical trauma, reduced physical activity, and the recovery period may intensify muscle loss and hinder the return to functional independence. In this setting, identifying sarcopenia and implementing exercise, physical therapy, rehabilitation, and prehabilitation strategies are relevant to preserving functional capacity and supporting recovery during the perioperative period. OBJECTIVE: To analyze the association between sarcopenia and functional outcomes in patients undergoing abdominal surgery, with emphasis on the repercussions for muscle strength, mobility, functional capacity, postoperative complications, and clinical recovery, as well as the contribution of physical therapy interventions, physical exercise, and prehabilitation strategies to preserving and restoring functioning during the perioperative period. METHODS: This is a descriptive and analytical literature review, conducted through an integrative literature review. The Virtual Health Library (BVS), Latin American and Caribbean Health Sciences Literature (LILACS), National Library of Medicine (PubMed), SciVerse Scopus (Scopus), and Scientific Electronic Library Online (SciELO) databases were searched. Studies published between 2020 and 2025 were considered, encompassing observational studies, clinical trials, intervention studies, systematic reviews, and meta-analyses related to sarcopenia and outcomes in patients undergoing abdominal surgery. Evidence related to muscle strength and mass, functional capacity, mobility, postoperative complications, length of hospital stay, physical recovery, prehabilitation, therapeutic exercise, physical therapy, and multimodal strategies for perioperative preparation and recovery was included. At the end of the selection process, 12 publications were classified according to their direct or indirect relationship with the population and the guiding question. RESULTS: The studies analyzed demonstrated an association between the presence of sarcopenia and worse outcomes in patients undergoing different abdominal surgical procedures, including gastrointestinal, colorectal, hepatic, and pancreatic surgery. Reduced muscle mass and strength were related to a higher occurrence of postoperative complications, poorer physical recovery, greater clinical vulnerability, and, in certain contexts, increased length of hospital stay and mortality. Studies involving patients undergoing abdominal surgery also indicated that preoperative identification of sarcopenia may assist in risk stratification and planning recovery strategies. In parallel, interventions based on physical exercise, resistance training, prehabilitation, and multimodal programs involving exercise and nutritional support showed potential to improve functional capacity and reduce the vulnerability associated with low muscle reserve. However, some of this evidence was obtained in specific surgical populations or in studies that did not exclusively select sarcopenic patients, and its applicability should be interpreted in context. CONCLUSIONS: The findings of this review suggest that sarcopenia represents a relevant factor associated with a worse functional and clinical course in patients undergoing abdominal surgery, being related to reduced muscle strength, impaired functional capacity, a higher risk of postoperative complications, and more complex recovery. Strategies involving physical therapy, physical exercise, resistance training, prehabilitation, and multimodal approaches may contribute to preserving or restoring functioning during the perioperative period, especially when directed early toward patients with greater muscle vulnerability. However, heterogeneity in surgical procedures, methods used to identify sarcopenia, interventions, and outcomes assessed, as well as the presence of indirect or contextual evidence, limits the generalizability of the results. Thus, the findings should be interpreted as evidence of a relevant association between sarcopenia and a worse course after abdominal surgery, reinforcing the importance of functional assessment and multidisciplinary care, with physical therapy participation, in preventing functional loss and supporting perioperative recovery.