Iván Alejandro Zamarron Segura

Major surgery induces a complex physiological stress response characterized by metabolic disruption, systemic inflammation, and accelerated protein catabolism, all of which significantly influence perioperative outcomes. Despite advances in surgical and anesthetic techniques, postoperative complications and delayed recovery remain common, particularly among patients with reduced functional reserve, malnutrition, or metabolic vulnerability. In this context, immunometabolic and nutritional prehabilitation has emerged as a proactive strategy aimed at optimizing patients’ physiological condition prior to surgery. This narrative review analyzes current evidence on immunometabolic and nutritional prehabilitation in major surgery, with a specific focus on its relevance to anesthesiology and perioperative medicine. The review synthesizes data related to functional capacity, postoperative morbidity, hospital length of stay, and feasibility of implementation across different healthcare settings. Emphasis is placed on multimodal prehabilitation approaches that integrate structured exercise, nutritional optimization, and immunonutritional principles, as well as their alignment with Enhanced Recovery After Surgery (ERAS) protocols. The findings highlight consistent associations between comprehensive prehabilitation strategies and improved perioperative trajectories, including better preservation of functional capacity, reduced overall postoperative morbidity, and shorter hospitalization. Additionally, the review explores the applicability of these strategies within diverse healthcare systems, with particular consideration of Mexico, Colombia, and Ecuador. By framing prehabilitation as a core component of anesthesiology-led perioperative care, this work supports a shift toward preventive, patient-centered models aimed at enhancing surgical resilience and recovery.