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Prehabilitation can improve the functional status of patients prior to major surgery, thereby reducing postoperative complications. The aim of this study was to document the current prehabilitation practices and preoperative assessment before major digestive surgery in francophone countries.
Materials and Methods
A questionnaire was sent by email to the members of the Groupe Francophone de Réhabilitation Améliorée après Chirurgie (GRACE) and users of GRACE Audit software at the end of 2019.
513 responses were obtained, of which 30% were from surgeons, 16% from anaesthetists, 24% from anaesthetist nurses, 10% from Enhanced Recovery After Surgery (ERAS) nurses, and 20% from others.
Preoperative assessment was usually performed by the anaesthetist (95%), the surgeon (84%), the cardiologist (58%), the geriatrician (41%), or the ERAS nurse (40%). The scores used were mainly the ASA (92%), the Performance Status (40%), and the NYHA (30%). Functional capacities were assessed in 70% of cases by the number of floors climbed by taking the stairs. Dynamic testing (exercise tests) was used in only 24% of cases. Anxiety and nutritional status were seldomly assessed.
All up, 97% of the respondents thought prehabilitation was beneficial, but only 50% practiced it, although 62% were amenable to delaying the surgery for 2–4 weeks if necessary.
This survey shows that preoperative assessment was subjective and that validated clinical scores and/or the recommended additional examinations were not used. Although these healthcare professionals were fully committed to ERAS and convinced of the benefits of prehabilitation programmes, the absence of standardised programmes meant the practice was marginal.Le texte complet de cet article est disponible en PDF.
Keywords : Enhanced recovery after surgery, prehabilitation, functional capacity, preoperative assessment, digestive surgery