Surgical Prehabilitation: Expansion to a Novel Outcome and Population Target

Background: Prehabilitation commonly involves screening patients for surgical risk, assessingfunction and vulnerabilities, and if indicated, delivering a multimodal intervention comprising exercise, nutrition, and psychological support to improve surgical outcomes. The aim of this dissertation was to expand the field of prehabilitation research to include a novel outcome, sleep health, and a novel surgical subgroup, living liver donors (LLDs). Objectives: Study 1 examined the relationship between sleep health, frailty and functional capacity in patients awaiting elective surgery. Study 2 synthesized and evaluated studies that delivered a preoperative intervention and measured a sleep health outcome. Study 3 evaluated the feasibility of conducting a Phase III randomized controlled trial (RCT) of prehabilitation versus usual care for LLDs. Methods: Study 1 was a cross-sectional study of patients awaiting elective surgery and used multiple linear regressions to evaluate the relationship between sleep health, functional capacity, and frailty while controlling for age, sex, neoadjuvant treatment status, and sleep disorder. Rates of sleep disturbance were reported with frequencies and percentages. Study 2 was a systematic review of preoperative interventions that report sleep outcomes. Study 3 was a feasibility RCT and randomized 30 LLDs to multimodal prehabilitation or usual care. Feasibility outcomes included eligibility, recruitment, attrition, adherence, and safety. Results: In Study 1, sleep health was associated with frailty and functional capacity. The prevalence of disturbed sleep was 78%. In Study 2, 47 preoperative interventions with 4937 participants were included. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to a comparator in 23 trials. The evidence was rated low to very low certainty primarily due to high risk of bias and inconsistency. In Study 3, 63 patients were eligible and 30 enrolled (48%). There were no intervention-related adverse events. Attrition was 33% and adherence across each of the components of prehabilitation was > 75%. Conclusion: Sleep health is associated with frailty and functional capacity (Study 1). Several intervention strategies initiated preoperatively may improve pre- and postoperative sleep health (Study 2). A Phase III RCT of prehabilitation versus usual care is feasible in LLDs (Study 3).

Department dc:contributor.department

Kinesiology and Physical Education

Year dc:date.issued

2025

Author dc:creator

• Sibley, Daniel

Advisor dc:contributor.advisor

• Santa Mina, Daniel

• Exercise
• Intervention
• Nutrition
• Prehabilitation
• Sleep health
• Surgery

Handle dc:identifier.uri

https://hdl.handle.net/1807/150230

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/150230