Ensuring Early Mobilization Within an Enhanced Recovery Program for Colorectal Surgery: A Randomized Controlled Trial

Area of Science:

• Colorectal Surgery
• Enhanced Recovery Programs (ERPs)
• Early Mobilization Protocols

Background:

• Early mobilization is a key component of Enhanced Recovery Programs (ERPs), yet adherence to recommended guidelines is often low.
• The effectiveness of dedicating specific staff resources to enhance early mobilization within ERPs remains unclear.

Purpose of the Study:

• To evaluate the impact of staff-directed facilitation of early mobilization on patient recovery following colorectal surgery within an established Enhanced Recovery Program (ERP).
• To compare outcomes between patients receiving facilitated mobilization and those receiving usual care within the ERP framework.

Main Methods:

• A randomized trial involving 99 colorectal surgery patients in an ERP.
• Patients were randomized to either usual care or facilitated mobilization (staff assisting with transfers and walking from postoperative days 0-3).
• The primary outcome was the return to preoperative walking capacity at 4 weeks, assessed by the 6-minute walk test.

Main Results:

• Facilitated mobilization significantly increased adherence to mobilization targets on postoperative days 0, 1, and 2.
• Patients in the facilitated group exhibited a greater than 2-fold increase in step count on postoperative days 1 and 2.
• No significant differences were observed between groups in the recovery of walking capacity at 4 weeks or other explored outcome measures.

Conclusions:

• Staff-directed facilitation of early mobilization within an ERP for colorectal surgery enhances in-hospital patient activity.
• This intervention did not lead to improved recovery of walking capacity or other clinical outcomes at 4 weeks post-surgery.
• The findings do not support the allocation of additional resources for early mobilization within ERPs.