{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:43:39Z","timestamp":1785851019575,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Prehabilitation has become an essential component of perioperative care in colorectal surgery, aiming to improve postoperative outcomes through multimodal interventions. However, its real-world implementation remains heterogeneous. This study aimed to evaluate the degree of implementation and variability of prehabilitation programs across colorectal surgery units in Spain. Methods: A national multicenter cross-sectional survey (VAPPER Survey) was conducted among colorectal surgery units. The questionnaire included 83 items addressing organizational structure, nutritional assessment, frailty screening, and multidisciplinary collaboration. Data were analyzed descriptively and expressed as frequencies and percentages. Results: A total of 104 hospitals participated. Prehabilitation programs were present in 79% (n = 82) of centers, while 21% (n = 22) reported no program. Nutritional screening was not performed in 21% (n = 22) of hospitals. Among those performing screening, MUST was the most frequently used tool (68%, n = 56), although considerable variability existed. Systematic use of GLIM criteria was reported in only 24% (n = 20), whereas 35% (n = 28) did not use GLIM and 41% (n = 34) applied it selectively. Frailty screening in patients \u226570 years was absent in 54% (n = 44) of centers, and geriatric involvement was limited and non-standardized. Conclusions: Prehabilitation is widely implemented in Spain but remains highly heterogeneous across all dimensions. The most relevant deficits are concentrated in systematic nutritional assessment, malnutrition diagnosis using standardized criteria, geriatric integration, and psychological support. Standardization of protocols, strengthening of multidisciplinary teams, and enhanced training in perioperative nutrition are priorities for optimizing outcomes in colorectal surgery.<\/jats:p>","DOI":"10.3390\/nu18152540","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:32:43Z","timestamp":1785846763000},"page":"2540","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variability in the Application and Principles of Prehabilitation and Enhanced Recovery (VAPPER Survey) Among Colorectal Surgery Units: A National Multicentre Survey"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6507-900X","authenticated-orcid":false,"given":"Carlos","family":"Cerd\u00e1n Santacruz","sequence":"first","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario de la Princesa, Instituto de Investigaci\u00f3n Sanitaria Princesa (IIS-IP), Universidad Aut\u00f3noma de Madrid (UAM), 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8136-5501","authenticated-orcid":false,"given":"Marta","family":"Carreras I Hoyos","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario de la Princesa, Instituto de Investigaci\u00f3n Sanitaria Princesa (IIS-IP), Universidad Aut\u00f3noma de Madrid (UAM), 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Dom\u00ednguez Serrano","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario Cl\u00ednico San Carlos, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0775-6217","authenticated-orcid":false,"given":"\u00d3scar","family":"Cano-Valderrama","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Complejo Hospitalario Universitario de Vigo, Instituto de Investigaci\u00f3n Sanitaria Galicia Sur, 36312 Vigo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0742-5664","authenticated-orcid":false,"given":"Mar\u00eda Luisa","family":"Reyes D\u00edaz","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-6691","authenticated-orcid":false,"given":"Elena","family":"Viejo Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Blanco Ter\u00e9s","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario San Jorge, 22004 Huesca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4091-9818","authenticated-orcid":false,"given":"Mireia","family":"Merichal Resina","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitari d\u2019Igualada, 08700 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2402-4106","authenticated-orcid":false,"given":"Marta","family":"Paniagua Garc\u00eda-Se\u00f1or\u00e1ns","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8920-9606","authenticated-orcid":false,"given":"Noelia","family":"Ib\u00e1\u00f1ez C\u00e1novas","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Clinico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4840-7988","authenticated-orcid":false,"given":"Francisco Javier","family":"Medina Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario Reina Sof\u00eda de C\u00f3rdoba, 14004 C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2230-2125","authenticated-orcid":false,"given":"Emilio","family":"Pe\u00f1a Ros","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital General Universitario Reina Sof\u00eda, 30003 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s","family":"Aldrey Cao","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3090-8330","authenticated-orcid":false,"given":"Leticia","family":"P\u00e9rez-Santiago","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"S\u00e1nchez Relinque","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario Punta de Europa, 11207 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainhoa","family":"Valle Rubio","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario de Getafe, 28905 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Garc\u00eda-Septiem","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario de Getafe, 28905 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4933-738X","authenticated-orcid":false,"given":"Elena","family":"Mart\u00edn P\u00e9rez","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Department, Hospital Universitario de la Princesa, Instituto de Investigaci\u00f3n Sanitaria Princesa (IIS-IP), Universidad Aut\u00f3noma de Madrid (UAM), 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"VAPPER Collaborative Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1097\/ALN.0000000000000795","article-title":"Promoting Perioperative Metabolic and Nutritional Care","volume":"123","author":"Gillis","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.anclin.2014.11.002","article-title":"Prehabilitation to Enhance Perioperative Care","volume":"33","author":"Carli","year":"2015","journal-title":"Anesthesiol. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.ciresp.2022.06.003","article-title":"\u201cOptimal recovery\u201d after colon cancer surgery in the elderly, a comparative cohort study: Conventional care vs. enhanced recovery vs. prehabilitation","volume":"101","author":"Santacruz","year":"2023","journal-title":"Cir. Esp. Engl. Ed."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/SLA.0000000000002293","article-title":"Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial","volume":"267","author":"Roca","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.clnu.2017.02.013","article-title":"ESPEN guideline: Clinical nutrition in surgery","volume":"36","author":"Weimann","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102481","DOI":"10.1016\/j.gassur.2026.102481","article-title":"Comparative effectiveness of preoperative prehabilitation modalities for postoperative recovery in colorectal cancer: A systematic review and network meta-analysis","volume":"30","author":"Xiang","year":"2026","journal-title":"J. Gastrointest. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4745","DOI":"10.1016\/j.clnu.2021.03.031","article-title":"ESPEN practical guideline: Clinical nutrition in surgery","volume":"40","author":"Weimann","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.clnu.2025.08.029","article-title":"ESPEN guideline on clinical nutrition in surgery\u2014Update 2025","volume":"53","author":"Weimann","year":"2025","journal-title":"Clin. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced Recovery After Surgery: A Review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1213\/ANE.0000000000001960","article-title":"The Association of Frailty with Outcomes and Resource Use After Emergency General Surgery: A Population-Based Cohort Study","volume":"124","author":"McIsaac","year":"2017","journal-title":"Anesth. Analg."},{"key":"ref_11","first-page":"CD006211","article-title":"Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Effective Practice and Organisation of Care Group, editor","volume":"2017","author":"Ellis","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sier, M.A.T., Godina, E., Mollema, O., Cox, M.P.P.J., Tweed, T.T.T., Greve, J.W., and Stoot, J.H.M.B. (2025). Participation and Adherence to Prehabilitation Programs for Colorectal Cancer. Nutrients, 17.","DOI":"10.3390\/nu17111792"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3179","DOI":"10.1007\/s11606-021-06737-1","article-title":"A Consensus-Based Checklist for Reporting of Survey Studies (CROSS)","volume":"36","author":"Sharma","year":"2021","journal-title":"J. Gen. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis (EWGSOP2)","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jamasurg.2023.0198","article-title":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","volume":"158","author":"Molenaar","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e305","DOI":"10.1016\/j.surge.2023.05.006","article-title":"The use of digital technologies to support home-based prehabilitation prior to major surgery: A systematic review","volume":"21","author":"Pedersen","year":"2023","journal-title":"Surgeon"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Olivero, C.A.F., Sarceda, J.R.J., Mart\u00edn, E.F., Villamayor, V.A., Gastardi, J.C., Mart\u00ednez, A.M.G., Santos, P., Manzanal, P.D.A., Santacruz, C.C., and Trancho, F.H. (2023). The Use of Fissios App\u00a9 as a Complement to a Face-to-Face Respiratory Physiotherapy Program versus an Attendance-Only Face-to-Face Physiotherapy Program in Patients Scheduled for Thoracic Surgical Procedures Reduces the Risk of Developing Postoperative Pulmonary Complications\u2014A Quasi-Experimental Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216774"},{"key":"ref_19","unstructured":"Grupo de Trabajo V\u00eda Cl\u00ednica RICA (2026). V\u00eda Cl\u00ednica RICA de Recuperaci\u00f3n Intensificada en Cirug\u00eda del Adulto, Grupo GERM, Universidad de Zaragoza. [3rd ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13741-023-00299-y","article-title":"Prehabilitation for patients with colorectal cancer: A snapshot of current daily practice in Dutch hospitals","volume":"12","author":"Molenaar","year":"2023","journal-title":"Perioper. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"(2021). ESCP Enhanced Recovery Collaborating Group. An international assessment of the adoption of enhanced recovery after surgery (ERAS\u00ae) principles across colorectal units in 2019\u20132020. Color. Dis., 23, 2980\u20132987.","DOI":"10.1111\/codi.15863"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2540\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T12:43:36Z","timestamp":1785847416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":21,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152540"],"URL":"https:\/\/doi.org\/10.3390\/nu18152540","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}