# Exploring Psychological Prehabilitation in Complex Abdominal Wall Reconstruction: A Prospective Pilot Study

## TL;DR

This pilot study shows that many patients undergoing complex abdominal surgery have psychological issues like anxiety and depression, which may affect their recovery.

## Contribution

The study is the first to prospectively explore psychological comorbidities in complex abdominal wall reconstruction patients.

## Key findings

- 69% of patients had at least one psychological risk factor, such as anxiety, depression, or PTSD.
- A link was observed between psychological comorbidities and prolonged postoperative pain.
- Only 46% of eligible patients completed all preoperative psychological assessments, indicating a high threshold for participation.

## Abstract

Prehabilitation strategies for patients with complex abdominal wall hernias primarily target physical optimization. However, existing psychological factors like anxiety, depression, and post-traumatic stress disorder are commonly observed in this population. Despite this, they remain underexplored notwithstanding their impact on recovery, complications, and quality of life. This study investigates the prevalence of psychological comorbidities in patients undergoing complex abdominal wall repair (CAWR).

In this prospective cohort study, consecutive patients planned for CAWR (September 2024-June 2025) were recruited. Complex hernias were predefined. Preoperative assessments focused on the presence of anxiety, depression, post-traumatic stress disorders, self-efficacy and quality of life by validated questionnaires: HADS, Mastery and PCL-5. Associations between psychological factors and postoperative pain scores, opioid use, length of stay and complications were explored.

A total of 16 (46%) out of 35 eligible patients completed all preoperative psychological questionnaires. Sixty-nine percent of patients screened positive for at least one psychological risk factor: sixty percent for anxiety and/or depression, thirteen percent for PTSD and fifty-three percent of patients had low self-efficacy. Median QoL score was 47/120.

This study identified that the threshold to participate in this study was very high. Secondly, two-thirds of patients assessed experienced one or more psychological comorbidities. A relation in these patients with prolonged postoperative pain was observed. These findings suggest that psychological comorbidities may represent a clinically relevant risk factor. Further research is warranted to better understand their role and to evaluate whether targeted psychological prehabilitation could improve outcomes.