Prehabilitation before pancreatic surgery in the Netherlands: insights from a nationwide survey among pancreatic surgeons.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.