Association Between Sarcopenia and Functional Outcomes in Patients Undergoing Abdominal Surgery: An Integrative Review

Abstract

Introduction: Sarcopenia is a condition characterized by a progressive reduction in muscle strength and mass, which may impair 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 poorer clinical outcomes. In addition, surgical trauma, reduced physical activity, and the recovery period may intensify muscle loss and hinder the return to functional independence. In this context, the identification of sarcopenia and the implementation of exercise, physical therapy, rehabilitation, and prehabilitation strategies are relevant for preserving functional capacity and promoting recovery during the perioperative period. Objective: To analyze the association between sarcopenia and functional outcomes in patients undergoing abdominal surgery, with an emphasis on its impact on muscle strength, mobility, functional capacity, postoperative complications, and clinical recovery, as well as the contribution of physical therapy interventions, physical exercise, and pre- rehabilitation strategies to the preservation and recovery of functionality during the perioperative period. Methods: This is a descriptive and analytical literature review conducted as an integrative literature review. The following databases were searched: Virtual Health Library (BVS), Latin American and Caribbean Literature on Health Sciences (LILACS), National Library of Medicine (PubMed), SciVerse Scopus (Scopus), and Scientific Electronic Library Online (SciELO). Studies published between 2020 and 2025 were considered, including observational studies, clinical trials, intervention studies, systematic reviews, and meta-analyses addressing 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 perioperative preparation and recovery strategies was included. At the end of the selection process, 12 publications were classified according to their direct or indirect relationship to the population and the guiding question.  Results: The analyzed studies demonstrated an association between sarcopenia and poorer outcomes in patients undergoing different abdominal surgical procedures, including gastrointestinal, colorectal, hepatic, and pancreatic surgeries. Reduced muscle mass and strength were associated with a higher incidence of postoperative complications, poorer physical recovery, greater clinical vulnerability, and, in some 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 in 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 vulnerability associated with low muscular reserve. However, part of this evidence was obtained from specific surgical populations or from studies that did not exclusively select patients with sarcopenia; therefore, its applicability should be interpreted within the appropriate clinical context. Conclusion: The findings of this review suggest that sarcopenia is an important factor associated with poorer functional and clinical outcomes 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 recovering functionality during the perioperative period, particularly when implemented early in patients with greater muscular vulnerability. However, the heterogeneity of surgical procedures, methods used to identify sarcopenia, interventions, and evaluated outcomes, in addition to the presence of indirect or contextual evidence, limits the generalizability of the findings. Therefore, the results should be interpreted as evidence of a relevant association between sarcopenia and poorer outcomes following abdominal surgery, reinforcing the importance of functional assessment and multidisciplinary care, including physical therapy, in preventing functional decline and promoting perioperative recovery.