Clinical nutrition (Edinburgh, Scotland) · 2026
Use and implementation of prehabilitation in major abdominal surgery: Results of an international survey.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Bezmarević Mihailo, Folwarski Marcin, Wobith Maria, Weimann Arved, Lobo Dileep N, Gianotti Luca, van Stijn Mireille, Klek Stanislaw, Soop Mattias, Ljungqvist Olle
Аннотация
BACKGROUND: Prehabilitation is increasingly recognized as an important component of multimodal preoperative optimization, yet its structure, delivery, and degree of integration into routine practice vary widely across healthcare systems. This survey aimed to examine current implementation strategies, multidisciplinary team configurations, and prevailing barriers to inform standardized adoption.
METHODS: We conducted a multinational, cross-sectional survey of surgical departments performing major abdominal surgery. The survey, disseminated via the European Society for Clinical Nutrition and Metabolism (ESPEN) and national surgical societies, captured institutional characteristics, prehabilitation implementation practices, delivery settings, multidisciplinary team composition, and 21 predefined barriers. The primary outcome was a 5-point prehabilitation integration score, a novel measure of prehabilitation components integration (1-5 Likert scale; 1 = not integrated, 5 = fully integrated into routine care). Associations were assessed using nonparametric tests and multivariable ordinary least squares regression.
RESULTS: A total of 200 departments from 45 countries participated. 31.5% reported a routine formal prehabilitation program; the mean (SD) integration score was 2.6 ± 1.1. Integration differed significantly by delivery setting, highest in departments with dedicated prehabilitation/ERAS units and rehabilitation services. Larger multidisciplinary teams were strongly associated with higher integration. In the final multivariable model, the presence of psychologists (β = +0.49, P = 0.002) and nurses (β = +0.35, P = 0.020) independently predicted greater integration, whereas lack of structured units (β = -0.51, P = 0.009), limited facility access (β = -0.39, P = 0.014), and absence of standardized protocols (β = -0.35, P = 0.031) were significant negative predictors. Hospital type and surgical volume showed no independent association.
CONCLUSION: Prehabilitation is not widely implemented as clinical practice among responding units. Integration of prehabilitation into a multidisciplinary care package is driven primarily by modifiable organizational factors rather than institutional size or academic status. Dedicated perioperative units, standardized protocols, adequate facilities, and inclusion of nurses and psychologists appear critical for successful implementation. These findings support a pragmatic, ERAS-aligned pathway for expanding prehabilitation within existing perioperative care frameworks.
METHODS: We conducted a multinational, cross-sectional survey of surgical departments performing major abdominal surgery. The survey, disseminated via the European Society for Clinical Nutrition and Metabolism (ESPEN) and national surgical societies, captured institutional characteristics, prehabilitation implementation practices, delivery settings, multidisciplinary team composition, and 21 predefined barriers. The primary outcome was a 5-point prehabilitation integration score, a novel measure of prehabilitation components integration (1-5 Likert scale; 1 = not integrated, 5 = fully integrated into routine care). Associations were assessed using nonparametric tests and multivariable ordinary least squares regression.
RESULTS: A total of 200 departments from 45 countries participated. 31.5% reported a routine formal prehabilitation program; the mean (SD) integration score was 2.6 ± 1.1. Integration differed significantly by delivery setting, highest in departments with dedicated prehabilitation/ERAS units and rehabilitation services. Larger multidisciplinary teams were strongly associated with higher integration. In the final multivariable model, the presence of psychologists (β = +0.49, P = 0.002) and nurses (β = +0.35, P = 0.020) independently predicted greater integration, whereas lack of structured units (β = -0.51, P = 0.009), limited facility access (β = -0.39, P = 0.014), and absence of standardized protocols (β = -0.35, P = 0.031) were significant negative predictors. Hospital type and surgical volume showed no independent association.
CONCLUSION: Prehabilitation is not widely implemented as clinical practice among responding units. Integration of prehabilitation into a multidisciplinary care package is driven primarily by modifiable organizational factors rather than institutional size or academic status. Dedicated perioperative units, standardized protocols, adequate facilities, and inclusion of nurses and psychologists appear critical for successful implementation. These findings support a pragmatic, ERAS-aligned pathway for expanding prehabilitation within existing perioperative care frameworks.