Browsing by Author "Gramlich, Leah M."

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    Prehabilitation for Enhanced Recovery After Colorectal Surgery
    (2020-06-08) Gillis, Chelsia; Fenton, Tanis R.; Gramlich, Leah M.; Culos-Reed, Susan Nicole; Sajobi, Tolulope T.
    Background: Postoperative morbidity is largely the product of the preoperative condition of the patient, the quality of surgical care provided, and the degree of surgical stress elicited. Enhanced Recovery After Surgery (ERAS) minimizes surgical stress with standardized evidence-based perioperative care; yet the ERAS care elements focus mainly on the intra- and postoperative periods, which may not sufficiently enhance recovery if preoperative patient-related factors have not been modified before surgery. Prehabilitation programs aim to enhance recovery by targeting the preoperative condition of the patient.Methods: This dissertation includes four manuscripts that broadly contribute to the evidence that supports the hypothesis that the patient’s preoperative status modifies outcomes in colorectal surgery. Results: First, intermediately frail and frail patients with poor functional walking capacity before surgery suffer more postoperative complications than patients with better functional walking capacity. Second, nutrition prehabilitation, with and without exercise, reduces mean length of hospital stay by two days. Third, patient interviews suggest that patients support the idea of using prehabilitation to enhance their preoperative condition. Finally, the last manuscript offers methodological suggestions to measure and analyze external variables as a means of advancing the prehabilitation literature and further enhancing patient outcomes. Conclusion: The findings of this doctoral dissertation add to the growing body of evidence that the process of surgical recovery begins before surgery. Prehabilitation interventions can be applied to support better postoperative recoveries.