Abstract Background Multimodal prehabilitation before elective surgery is a strategy to optimize patient’s clinical condition, aiming to reduce complications. In Crohn’s disease, patients frequently present with unfavorable conditions as bowel obstruction, perforation, or immunosuppression, which increase postoperative risks. However, evidence regarding the impact of prehabilitation in this subgroup remains scarce. Methods Retrospective observational study conducted in Crohn’s disease patients undergoing elective surgery between January 2010 and December 2024. Two groups: (1) prehabilitated, patients with bowel obstruction or perforation, admitted for a prehabilitation and scheduled for elective surgery; (2) non-prehabilitated patients without preoperative complications. Risk factors like previous surgeries, preoperative biological treatment, obesity, SLD or MASLD were analysed. The primary endpoint was the incidence of severe complications and total number of complications during hospitalization. Secondary endpoints included surgical site infection, transfusion, nasogastric tube requirement, prolonged total parenteral nutrition (4 days), reoperation, readmission, hospital stay, and biological, clinical and endoscopic recurrence at 12 months. Results 106 patients were enrolled (43 prehabilitated, 62 non-prehabilitated). Only difference was the presence of bowel obstruction or perforation at admission. Severe complications occurred in 35% of the cases in prehabilitation group vs 19% in non-prehabilitated group (p = 0.060), and at least one complication in 35% vs 24% (p = 0.214) respectively. High compliance of the different measures of the prehabilitation program (more than 75% of the measures) was associated with a lower severe complication rate (31% vs 50%). Overall hospital stay for the prehabilitation group was 35.7 days vs 5.0 days for the non-prehabilitation group (p 0.001), 28.0 vs 2.8 days preoperatively (p 0.001), and 6.5 vs 4.2 days postoperatively (p 0.001). Biological recurrence (Calprotectin 150 at 12m) was 18.2% n the prehabiliation group vs 26.9% in the non-prehabilitation group (p = 0.354). Clinical recurrence at 12 months was 6.1% vs 21.8% (p = 0.050). Endoscopic recurrence (Rutgeerts score ≥i2) was 43.3% vs 48.0% (p = 0.685). None of the analysed risk factors were associated with severe complications or a higher risk of clinical, biological or endoscopic recurrence. SLD and MASLD were associated with longer hospital stay. Conclusion Multimodal prehabilitation in patients with Crohńs disease presenting severe bowel obstruction or perforation is associated with postoperative complication and endoscopic recurrence rates comparable to those of favourable patients. High protocol compliance was associated with fewer severe complications. Conflict of interest: Prof. Dr. Gómez Ruiz, Marcos: No conflict of interest Rivas, Coral: no conflicts Cagigas Fernández, Carmen: No conflict of interest García, María José: Other: MJ García has received financial support for travelling and educational activities from Janssen, Pfizer, Abbvie, Takeda and Ferring. Cristobal Poch, Lidia: No conflict of interest Cifrian Canales, Isabel: No conflict of interest Castro Senosiain, Beatriz: No conflict of interest Garcia Chiloeches, Alba: No conflict of interest Arias-Loste, Maria Teresa: No conflict of interest Gabriel, Marin: No conflict of interest Rivero Tirado, Montserrat: No conflict of interest Castillo Diego, Julio: No conflict of interest
Ruiz et al. (Thu,) studied this question.