dc.contributor.advisor |
Hill, A |
en |
dc.contributor.author |
Lemanu, Daniel |
en |
dc.date.accessioned |
2014-12-07T22:43:23Z |
en |
dc.date.issued |
2014 |
en |
dc.identifier.citation |
2014 |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/23701 |
en |
dc.description.abstract |
Aim To evaluate whether bariatric surgery can be made more cost-effective and to improve early and long-term outcomes Methods The bariatric procedure offered at Counties Manukau District Health Board (CMDHB), Auckland, is laparoscopic sleeve gastrectomy (LSG). Therefore this thesis deals solely with surgical recovery and outcomes after LSG. To determine the current status of LSG at CMDHB, a retrospective review describing the outcomes of the first 400 patients to have LSG at our institution was performed, the results of which would be used to measure the effect of clinical interventions described in later chapters. The thesis was then divided into two distinct phases. The first phase was to determine whether optimised and standardised perioperative care would lead to improved surgical recovery, improved clinical outcomes and reduced perioperative costs. Implementation of an Enhanced Recovery After Surgery (ERAS) programme was hypothesised to be an effective way to achieve this. A bariatric ERAS programme was therefore formulated by performing an extensive review of the literature evaluating perioperative care interventions in major abdominal surgery. In this review, prehabilitation was identified as an intervention which could be investigated in later chapters as a means to improve surgical recovery. Once formulated, the ERAS programme was evaluated within a randomised controlled trial. The second phase of the thesis was to determine whether improved exercise behaviour would lead to improved surgical outcomes. A prospective study was first performed to describe the long-term efficacy of LSG at our institution in order to determine the extent to which outcomes could be improved. A systematic review was then performed to determine whether a text-message intervention could be used to improve exercise adherence in order to optimise preoperative exercise behaviour. The efficacy of text-messages and preoperative exercise were then investigated within a randomised controlled trial. |
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dc.publisher |
ResearchSpace@Auckland |
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dc.relation.ispartof |
PhD Thesis - University of Auckland |
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dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. |
en |
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
en |
dc.rights.uri |
http://creativecommons.org/licenses/by-nc-sa/3.0/nz/ |
en |
dc.title |
Optimising the Bariatric Perioperative Journey |
en |
dc.type |
Thesis |
en |
thesis.degree.grantor |
The University of Auckland |
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thesis.degree.level |
Doctoral |
en |
thesis.degree.name |
PhD |
en |
dc.rights.holder |
Copyright: The Author |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/OpenAccess |
en |
pubs.elements-id |
468250 |
en |
pubs.record-created-at-source-date |
2014-12-08 |
en |
dc.identifier.wikidata |
Q112906029 |
|