Multimodal prehabilitation significantly reduces mortality and readmission rates in high-risk gastrointestinal surgery patients.

• Participants had 30-day mortality at 32% of expected rates and readmission at 93% of expected rates.
• Baseline dyspnea (47% in nonideal outcomes) and disseminated cancer are key risk factors linked to higher 30-day readmissions.

Surgeons should closely evaluate patients with dyspnea, as it represents a modifiable risk that may require targeted management beyond standard prehabilitation.

• Open surgical approaches were associated with worse outcomes (82% in nonideal cases).