L.R. Jønsson1,2, J. Orbæk3, M.L. Lauritsen3, N.B. Foss4, M.T. Kristensen1,5,2
1Copenhagen University Hospital Hvidovre, Department of Physiotherapy and Occupational Therapy, Hvidovre, Denmark, 2Copenhagen University Hospital Hvidovre, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre, Denmark, 3Copenhagen University Hospital Hvidovre, Gastro Unit Surgical Division, Hvidovre, Denmark, 4Copenhagen University Hospital Hvidovre, Department of Anesthesiology and Intensive Care Medicine, Hvidovre, Denmark, 5Copenhagen University Hospital Hvidovre, Department of Orthopedic Surgery, Hvidovre, Denmark
Background: Acute high-risk abdominal (AHA) surgery is associated with high risk of postoperative complications, mortality and prolonged hospital stay. Early mobilization after AHA surgery is therefore considered essential to reduce postoperative pulmonary complications and preventing loss of function. However, feasibility of early and intensive mobilization after emergency abdominal surgery has not yet been determined.
Purpose: The primary purpose was to evaluate the feasibility of a predefined early intensive mobilization protocol commenced on day of surgery and continued daily during the first postoperative week following AHA surgery. Secondary purposes were to examine physical activity and factors limiting mobilization after AHA surgery.
Methods: Fifty consecutive patients following AHA surgery, of whom only 2 dropped out, were enrolled in this non-randomized feasibility trail. The feasibility of the mobilization protocol for the first 7 postoperative days (POD) were evaluated separately in accordance to the percentage of patients: 1) mobilized within 24-hours after surgery, 2) mobilized ≥4 times per day and 3) achieving the daily predefined goals of “time out of bed” and “walking distance”. If >80% of the patients achieved the goal, the intervention was considered feasible, and if ≤80% achieved the goal some modification of the protocol may be needed.
Results: The mean age of the 48 included patients (48% women) were 60.9 (range: 22-89) years. On POD1 the patients were lying in bed a mean of 19 (SD:4.6) hours and 45% needed assistance when mobilized. Still, 92% of the patients were mobilized within 24-hours after surgery and >80% were mobilized at least 4 times per day. On POD1-3, 70-89% of the patients achieved the daily goals of “time out of bed” and “walking distance”. Among patients still hospitalized after POD 3 (n=37), only 52-75% were able to achieve the goals during POD4-7. The factors limiting level of mobilization were primarily fatigue, pain and dizziness. Patients non-independently mobilized on POD3 (28%) were significantly (p<0.013) fewer hours out of bed (mean (SD): 4.0 (3.4) vs. 8.4 (4.3) hours), less able to achieve the goals of “time out of bed” (45% vs. 94%) and “walking distance” (62% vs. 94%) and hospitalized more days (median (IQR): 14 (11-22) vs. 6 (4-9)) compared to patients independently mobilized after AHA surgery.
Conclusion(s): Early intensive mobilization following AHA surgery seems well tolerated, and the intensive mobilization protocol is considered feasible with some modification. Patients non-independently mobilized after AHA surgery are characterized by decreased physical activity.
Implications: Early intensive mobilization should be considered as part of acute care programs following AHA surgery to prevent loss of physical function and postoperative pulmonary complications. The clinical efficacy should be investigated in a definitive RCT.
Funding, acknowledgements: This work was supported by the Copenhagen University Hospital, Hvidovre, Denmark.
Keywords: abdominal surgery, Pulmonary complications, Early mobilization
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Copenhagen University Hospital, Hvidovre, Denmark
Committee: The Danish National Committee on Health Research Ethics
Ethics number: H-18034444
All authors, affiliations and abstracts have been published as submitted.
