Hoeijmakers Lis S M, Driessens Heleen, Buis Carlijn I, Olde Damink Steven W M, Klaase Joost M, Dulk Marcel den
Department of Surgery, Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Perioper Med (Lond). 2025 Jul 31;14(1):82. doi: 10.1186/s13741-025-00569-x.
Prehabilitation programs are increasingly used to optimize patients before pancreatic surgery. A prehabilitation program should include screening, assessment, intervention, and reassessment of multiple patient-related modifiable risk factors. Consensus on the content of a prehabilitation program and which patients should receive prehabilitation is missing. This study aims to assess current preoperative screening practices, surgeons' opinions, and knowledge of prehabilitation and identify existing prehabilitation programs for pancreatic surgery in the Netherlands.
A nationwide descriptive cross-sectional study was conducted. All 15 hospitals providing pancreatic surgery in the Netherlands were included, and an online survey was sent to only one pancreatic surgeon per hospital. The survey was developed by the authors of this paper and based on a previously published survey for prehabilitation in colorectal surgery. Logical ordering and adaptive questioning were used.
All 15 surgeons responded, and they were all familiar with the term prehabilitation. Twelve hospitals (80%) offered prehabilitation, and in the majority of hospitals (7/12), prehabilitation was offered to all patients. Prehabilitation programs included multiple domains, whereby physical fitness and nutrition were most often included and mental resilience was the least often included domain. Each hospital implemented a different prehabilitation program in terms of included domains, screening methods, and interventions. For the majority of the domains, two or more different forms of screening and three or more different interventions were used across hospitals. A total of 53.3% of surgeons were willing to postpone the surgery of pancreatic malignancies up to a maximum of 4 weeks, 20% up to a maximum of 6 weeks, and 26.7% as long as necessary to optimize the patients' preoperative overall fitness.
Pancreatic surgeons in the Netherlands have knowledge of prehabilitation, but high variability exists in current practice regarding prehabilitation programs. There is a need for a uniform standardized prehabilitation program to be able to implement prehabilitation in the standard preoperative care pathway and enable comparison of results across hospitals.
术前康复计划越来越多地用于优化胰腺手术患者的术前状态。术前康复计划应包括对多种与患者相关的可改变风险因素进行筛查、评估、干预和重新评估。目前对于术前康复计划的内容以及哪些患者应接受术前康复尚未达成共识。本研究旨在评估荷兰目前的术前筛查实践、外科医生的意见和对术前康复的了解，并确定荷兰现有的胰腺手术术前康复计划。
开展了一项全国性描述性横断面研究。纳入了荷兰所有15家提供胰腺手术的医院，每家医院仅向一名胰腺外科医生发送在线调查问卷。该调查问卷由本文作者编制，基于先前发表的一项关于结直肠手术术前康复的调查问卷。采用了逻辑排序和适应性提问。
所有15名外科医生均作出回应，他们都熟悉术前康复这一术语。12家医院（80%）提供术前康复，在大多数医院（7/12），所有患者均可接受术前康复。术前康复计划包括多个领域，其中身体适应性和营养最常被纳入，心理恢复力是最少被纳入的领域。就所纳入的领域、筛查方法和干预措施而言，每家医院实施的术前康复计划各不相同。对于大多数领域，各医院使用了两种或更多不同形式的筛查以及三种或更多不同的干预措施。共有53.3%的外科医生愿意将胰腺恶性肿瘤手术推迟最多4周，20%的医生愿意推迟最多6周，26.7%的医生愿意根据需要尽可能长时间推迟手术，以优化患者的术前总体身体状态。
荷兰的胰腺外科医生了解术前康复，但目前术前康复计划的实践存在很大差异。需要制定统一的标准化术前康复计划，以便能够在标准的术前护理路径中实施术前康复，并实现各医院之间结果的比较。
