Optimizing prehabilitation in pancreatic surgery: towards patient-centred care
Optimizing prehabilitation in pancreatic surgery: towards patient-centred care
Pancreatic surgery is a complex and major procedure, and many patients still develop complications afterwards. The risk of these complications is determined not only by the disease and surgery itself, but also by patient-related factors such as physical fitness, nutritional status and mental resilience. Identifying and improving these modifiable risk factors before surgery is known as prehabilitation.
This thesis of Heleen Driessens explored how prehabilitation for pancreatic surgery can be further developed and integrated into routine clinical care. A nationwide study showed that prehabilitation is already offered in many Dutch hospitals, but programmes vary considerably in content. The research also identified practical ways to improve patient screening and monitoring. A short cycling test, the modified steep ramp test, proved useful for assessing physical fitness. Continuous glucose monitoring revealed that high blood glucose levels around the time of surgery are common. Low health literacy was also associated with less favourable postoperative outcomes. In addition, prehabilitation was associated with a lower incidence of postoperative delirium.
Together, these findings show that prehabilitation extends well beyond physical training and calls for a broad, patient-centred approach to prepare patients for surgery. The next step is to develop a standardized yet personalized programme that is accessible to all patients and targets the risk factors relevant to each individual. Outcomes should focus not only on complications, but also on recovery and quality of life. An ongoing nationwide study involving thirteen Dutch hospitals is implementing this prehabilitation approach and investigates the effect on patient ouctomes.