Revista Tópicos · Oct 21, 2026

MULTIMODAL PREHABILITATION AS A STRATEGY FOR MODULATING SURGICAL RISK: EFFECTS OF FUNCTIONAL RESERVE, NUTRITIONAL STATUS, AND FRAILTY ON POSTOPERATIVE COMPLICATIONS

By Martinez JSC, Serrano MAS

Multimodal prehabilitation is a perioperative strategy intended to increase the patient's capacity to withstand surgical stress through a combination of physical exercise, nutritional optimization, and psychobehavioral interventions before surgery. This article critically analyzes how functional reserve, nutritional status, and frailty influence postoperative complications and the extent to which multimodal programs can modulate this risk. This is a qualitative systematized review with narrative synthesis, based on perioperative nutrition guidelines, systematic reviews, meta-analyses, and randomized clinical trials. Recent evidence indicates that preoperative exercise and nutritional support may reduce complications, improve functional capacity, and, in some settings, shorten hospital stays, although the magnitude of the benefits varies according to the type of surgery, risk profile, and components used. Frail patients, older adults, and high-risk patients appear to have the greatest potential for benefit, particularly when prehabilitation is initiated after structured screening and tailored to functional reserve and nutritional status. Malnutrition, sarcopenia, and frailty are consistently associated with worse outcomes, but they are not equivalent constructs and should be assessed separately. It is concluded that multimodal prehabilitation should be understood as an intervention for risk stratification and modulation, rather than as a single protocol. Its integration into perioperative care requires early screening, individualized goals, adherence monitoring, and coordination with enhanced recovery after surgery principles.

doi.org/10.70773/revistatopicos/792470340 Open access Interventions