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The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A
Tanya Castelino1, Julio F Fiore1, Petru Niculiseanu1
1Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Early mobilization protocols after surgery show mixed results. While beneficial, evidence is limited due to poor study quality, highlighting the need for better research on effective early mobilization strategies.
Area of Science:
- Surgical Care
- Postoperative Recovery
- Evidence-Based Medicine
Background:
- Early mobilization is crucial for postoperative care.
- Optimal implementation of early mobilization protocols remains unclear.
- This review examines early mobilization's impact on abdominal and thoracic surgery outcomes.
Purpose of the Study:
- To systematically review evidence on early mobilization protocols.
- To assess the impact of specific protocols on postoperative outcomes.
- To identify effective early mobilization strategies for surgical patients.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched 8 electronic databases for comparative studies.
- Assessed study quality using the Downs and Black tool.
Main Results:
- Included 8 studies (4 abdominal, 4 thoracic surgery).
- No significant differences in postoperative complications reported.
- Some studies indicated benefits in reduced hospital stay, improved gastrointestinal function, performance, and patient-reported outcomes.
- Overall study quality was poor.
Conclusions:
- Limited high-quality evidence exists for early mobilization protocols in abdominal and thoracic surgery.
- Results are conflicting, and study quality is a concern.
- While bed rest is detrimental, effective mobilization protocols require further research to guide clinical practice.
Background:
Early mobilization is considered an important element of postoperative care; however, how best to implement this intervention in clinical practice is unknown. This systematic review summarizes the evidence regarding the impact of specific early mobilization protocols on postoperative outcomes after abdominal and thoracic surgery.
Method:
The review was performed according to PRISMA guidelines. We searched 8 electronic databases to identify studies comparing patients receiving a specific protocol of early mobilization to a control group. Methodologic quality was assessed using the Downs and Black tool.
Results:
Four studies in abdominal surgery (3 randomized controlled trials [RCTs] and 1 observational prospective study) and 4 studies in thoracic surgery (3 RCTs and 1 observational retrospective study) were identified. None of the 5 studies evaluating postoperative complications reported differences between groups. One of 4 studies evaluating duration of stay reported a significant decrease in the intervention group. One of 3 studies evaluating gastrointestinal function reported differences in favor of the intervention group. One of 4 studies evaluating performance-based outcomes reported differences in favor of the intervention group. One of 5 studies evaluating patient-reported outcomes reported differences in favor of the intervention group. Overall methodologic quality was poor.
Conclusion:
Few comparative studies have evaluated the impact of early mobilization protocols on outcomes after abdominal and thoracic surgery. The quality of these studies was poor and results were conflicting. Although bed rest is harmful, there is little available evidence to guide clinicians in effective early mobilization protocols that increase mobilization and improve outcomes.
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