IMPACT OF EARLY MOBILIZATION ON RECOVERY OUTCOMES AFTER ABDOMINAL SURGERY: EVIDENCE FROM A TERTIARY CARE HOSPITAL

Abstract

Background: Mobilization immediately after surgery of the abdomen is suggested to decrease the postoperative complications, length of stay (LOS), and speed up the functional recovery. There is still limited evidence of tertiary care hospitals in the developing regions. Purpose: To determine how an early mobilization protocol influences the outcomes of recovery after the performance of elective abdominal surgery in a teaching hospital with the high level of care. Methods: It was a prospective cohort study that compared the results of patients that were given a formalized protocol of early mobilization (EM group) and those that were given standard postoperative care (SC group). Adults that had an elective open or laparoscopic surgery of the abdominal area were enrolled. The main outcome was length of stay in the hospital. Secondary criteria consisted of postoperative pulmonary complications (PPCs), ileus, postoperative pain scores on a numeric rating scale (NRS), the first bowel movement, 48-hour-ambulation distance and 30-day readmission. Continuous variables were used in t-tests or Mann-Whitney U tests and categorical variables in the chi-square tests through statistical analysis. Multivariate logistic and linear regression models were determined according to age, ASA condition, surgery method, and the burden of comorbidities. Results: 200 patients were selected (EM = 100, SC = 100). Median LOS were 4.2 days (IQR 3.5-5.0) in EM, and 6.1 days (IQR 5.0-7.6) in SC (p < 0.001). The PPCs were found in 4 percent of EM and 12 percent of SC (p = 0.04). Mean time of first bowel movement: 48 hours (EM) vs 72 hours (SC) (p < 0.001). There was no significant difference in mean NRS at 24 hours (EM 3.2 vs SC 4.1, p = 0.01).  Findings: Standardized early mobilization protocol following abdominal surgery was found to be linked with reduction in hospital stay, reduction in pulmonary complications, earlier bowel functioning and low early pain scores. Structured mobilization programs in the tertiary-care settings could enhance the postoperative recovery.

Keywords: Early Mobilization, Abdominal Surgery, Postoperative Recovery, Enhanced Recovery After Surgery, Length Of Stay