Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have?

European Journal of Surgical Oncology, vol. 47, pp. 551–559

Abstract

Due to an aging population and the related growing number of less physically fit patients with multiple comorbidities, adequate perioperative care is a new and rapidly developing clinical science that is becoming increasingly important. This narrative review focuses on enhanced recovery after surgery (ERAS®) programmes and the growing interest in prehabilitation programmes to improve patient- and treatment-related outcomes in older patients undergoing hepatopancreatobiliary (HPB) surgery. Future steps required in the further development of optimal perioperative care in HPB surgery are also discussed. Multidisciplinary preoperative risk assessment in multiple domains should be performed to identify, discuss, and reduce risks for optimal outcomes, or to consider alternative treatment options. Prehabilitation should focus on high-risk patients based on evidence-based cut-off values and should aim for (partly) supervised multimodal prehabilitation tailored to the individual patient's risk factors. The program should be executed in the living context of these high-risk patients to improve the participation rate and adherence, as well as to involve the patient's informal support system. Developing tailored (multimodal) prehabilitation programmes for the right patients, in the right context, and using the right outcome measures is important to demonstrate its potential to further improve patient- and treatment-related outcomes following HPB surgery.

Authors 3

1. Bart Chateau Bongers corresponding

   Maastricht University · Care and Public Health Research Institute

   Affiliation as printed

   Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. Electronic address: bart.bongers@maastrichtuniversity.nl

   Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands

   Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands

2. Cornelis H.C. Dejong corresponding Aachen Department of Surgery, Uniklinikum

   RWTH Aachen University · Universitätsklinikum Aachen · Maastricht University Medical Centre

   Affiliation as printed

   Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany. Electronic address: chc.dejong@mumc.nl

   Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands

   Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany

3. Marcel den Dulk corresponding Aachen Department of Surgery, Uniklinikum

   RWTH Aachen University · Universitätsklinikum Aachen · Maastricht University Medical Centre

   Affiliation as printed

   Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany. Electronic address: marcel.den.dulk@mumc.nl

   Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands

   Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany