Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial

Abstract

Background: Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery.

Methods: A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test).

Results: There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001).

Conclusion: Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation.

Trial registration: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

Keywords: Clinical trial; Length of hospital stay; Non-cardiac surgery; Preoperative time; Walking.

Conflict of interest statement

The authors OLC, MHG, MR, CPB, ME, and CP declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

Consort flow diagram

Fig. 2

Time median (minutes/week) of physical activity measured using accelerometers, by intensity and group. Estimations are based on 20 patients for each group. Intensity: low (1.5—3.0 MET), moderate (3.1—6.0 MET), and vigorous (6.1—9.0 MET). p values estimated were obtained via the Kruskal–Wallis test

Fig. 3

Time at discharge (of hospital stay) in the intervention and control group. No differences were noted in the time of stay between the groups. (log-rank test p = 0.367)

Fig. 4

Time to the first ambulation during hospitalization of intervention and control group. No differences were noted in the first walk during the post-operatory between both groups (log-rank test p = 0.299)