Optimizing perioperative care in abdominal surgery: towards a personalized treatment using preoperative risk assessment and the patient’s perspective

The goal of this thesis was to investigate strategies to improve patient-tailored perioperative care for major abdominal surgery, with a focus on colorectal cancer surgery.
Part I of this thesis focussed on preoperative risk assessment and options to more accurately select patients at risk for postoperative morbidity using preoperative physical fitness-related variables. Both aerobic fitness and body composition appeared to have an important yet different association with postoperative morbidity and seem to include important predictors in preoperative risk assessment. Part I also analysed the feasibility of improving preoperative physical fitness (prehabilitation) and assessed the value of preoperative outcome prediction in case of severe complications requiring admission to an intensive care unit.
Part II focussed on the perspective and experience of the patient regarding current care before and after major abdominal surgery. These results provided patient-perceived items to improve perioperative care. Furthermore, patients’ experiences after critical care were used to improve future shared decision-making regarding life-sustaining treatments.