Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

Rose-Marie W Thörn, Jan Stepniewski, Hans Hjelmqvist, Anette Forsberg, Rebecca Ahlstrand, Olle Ljungqvist, Rose-Marie W Thörn, Jan Stepniewski, Hans Hjelmqvist, Anette Forsberg, Rebecca Ahlstrand, Olle Ljungqvist

Abstract

Background: Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach.

Methods: This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space.

Results: In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred.

Conclusions: Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

Trial registration: ClinicalTrials.gov NCT03357497.

Conflict of interest statement

Olle Ljungqvist is the co-founder and current chairman of the ERAS® Society and founder and shareholder of Encare AB, Sweden, which manages the ERAS® Interactive Audit System. Hans Hjelmqvist is member of the Swedish Chapter of the ERAS® Society. The other authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
SOMS level achievement per time period in the PACU (n = 42). *Discharge from PACU (n = 11) ** discharge from PACU (n = 29)

References

    1. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS((R))) society recommendations: 2018. World J Surg. 2019;43(3):659–695. doi: 10.1007/s00268-018-4844-y.
    1. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101(3):172–188. doi: 10.1002/bjs.9394.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–298. doi: 10.1001/jamasurg.2016.4952.
    1. Smart NJ, White P, Allison AS, Ockrim JB, Kennedy RH, Francis NK. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis. 2012;14(10):e727–e734. doi: 10.1111/j.1463-1318.2012.03096.x.
    1. Svensson-Raskh A, Schandl A, Holdar U, Fagevik Olsén M, Nygren-Bonnier M. "I Have everything to win and nothing to lose": patient experiences of mobilization out of bed immediately after abdominal surgery. Phys Ther. 2020;100(12):2079–2089. doi: 10.1093/ptj/pzaa168.
    1. Parry SM, Remedios L, Denehy L, Knight LD, Beach L, Rollinson TC, et al. What factors affect implementation of early rehabilitation into intensive care unit practice? A qualitative study with clinicians. J Crit Care. 2017;38:137–143. doi: 10.1016/j.jcrc.2016.11.005.
    1. Dock W. The evil sequelae of complete bed rest. J Am Med Assoc. 1944;125(16):1083–1085. doi: 10.1001/jama.1944.02850340009004.
    1. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet. 1999;354(9186):1229–1233. doi: 10.1016/S0140-6736(98)10063-6.
    1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362(9399):1921–1928. doi: 10.1016/S0140-6736(03)14966-5.
    1. Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377–1388. doi: 10.1016/S0140-6736(16)31637-3.
    1. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658. doi: 10.1186/s13054-014-0658-y.
    1. Ambrosino N, Gabbrielli L. Physiotherapy in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010;24(2):283–289. doi: 10.1016/j.bpa.2010.02.003.
    1. Urell C, Emtner M, Hedenstrom H, Tenling A, Breidenskog M, Westerdahl E. Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery—a randomised controlled trial. Eur J Cardiothorac Surg. 2011;40(1):162–167. doi: 10.1016/j.ejcts.2010.10.018.
    1. Fagevik Olsen M, Lannefors L, Westerdahl E. Positive expiratory pressure—common clinical applications and physiological effects. Respir Med. 2015;109(3):297–307. doi: 10.1016/j.rmed.2014.11.003.
    1. Currie A, Soop M, Demartines N, Fearon K, Kennedy R, Ljungqvist O. Enhanced recovery after surgery interactive audit system: 10 years' experience with an international web-based clinical and research perioperative care database. Clin Colon Rectal Surg. 2019;32(1):75–81. doi: 10.1055/s-0038-1673357.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121.x.
    1. Liang SS, Ying AJ, Affan ET, Kakala BF, Strippoli GF, Bullingham A, et al. Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. Cochrane Database Syst Rev. 2019;10:CD012310.
    1. Elias KM, Stone AB, McGinigle K, Tankou JI, Scott MJ, Fawcett WJ, et al. The reporting on ERAS compliance, outcomes, and elements research (RECOvER) checklist: a joint statement by the ERAS((R)) and ERAS((R)) USA societies. World J Surg. 2019;43(1):1–8. doi: 10.1007/s00268-018-4753-0.
    1. Svensson-Raskh A, Schandl AR, Stahle A, Nygren-Bonnier M, Fagevik Olsen M (2021) Mobilization started within 2 hours after abdominal surgery improves peripheral and arterial oxygenation: a single-center randomized controlled trial. Phys Ther 101(5)
    1. Fagevik Olsen M, Becovic S, Dean E. Short-term effects of mobilization on oxygenation in patients after open surgery for pancreatic cancer: a randomized controlled trial. BMC Surg. 2021;21(1):185. doi: 10.1186/s12893-021-01187-2.
    1. Savikko J, Vikatmaa L, Hiltunen AM, Mallat N, Tukiainen E, Salonen SM et al (2020) Enhanced recovery protocol in laparoscopic liver surgery. Surg Endosc
    1. Fiore JF, Jr, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn O, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery: a randomized controlled trial. Ann Surg. 2017;266(2):223–231. doi: 10.1097/SLA.0000000000002114.
    1. McKenna NP, Bews KA, Shariq OA, Habermann EB, Behm KT, Kelley SR, et al. Is same-day and next-day discharge after laparoscopic colectomy reasonable in select patients? Dis Colon Rectum. 2020;63(10):1427–1435. doi: 10.1097/DCR.0000000000001729.
    1. Brown D, McCormack B. Developing postoperative pain management: utilising the promoting action on research implementation in health services (PARIHS) framework. Worldviews Evid Based Nurs. 2005;2(3):131–141. doi: 10.1111/j.1741-6787.2005.00024.x.
    1. Burger JW, van 't Riet M, Jeekel J (2002) Abdominal incisions: techniques and postoperative complications. SJS 91(4):315–321
    1. Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (ERAS) protocols. Clin Colon Rectal Surg. 2019;32(2):121–128. doi: 10.1055/s-0038-1676477.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅