Been gone a...few years? in terms of updates... Whats changed that I should be aware of?

I tend to come back every six months and there’s enough updates to catch up on - a few years would make my head spin.

I think all the things you mentioned have only been introduced since 0.D (released March this year), so the change log for that should help:

Since then there’s been a lot of work on the player faction bases and NPCs in general, radio contact with followers, new lab types (I think the overground research facility was post 0.D?), mutagen now requires expert lab equipment, “hunger” is based on stomach contents rather than the over all calories, pet armor for dogs (and horses?), rideable horses…One small but brilliant addition is that climbing to high points will give you a much larger view of the map (radio towers are your friend)

Reddit has weekly changelogs which is nice:
https://www.reddit.com/r/cataclysmdda/comments/dnxupi/cdda_changelog_october_27_2019/