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Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial
Line Rokkedal Jønsson1, Nicolai Bang Foss2, Janne Orbæk2
1From the Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark (Rokkedal Jønsson, Nygaard Sejrsen); the Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark (Bang Foss); the Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Bang Foss, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark (Orbæk, Laksafoss Lauritsen); the Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen, Denmark (Tange Kristensen) linerokkedal@hotmail.com.
Background:
Mobilization after emergency abdominal surgery is considered essential to facilitate rehabilitation and reduce postoperative complications. The aim of this study was to evaluate the feasibility of early intensive mobilization after acute high-risk abdominal (AHA) surgery.
Methods:
We conducted a nonrandomized, prospective feasibility trial of consecutive patients after AHA surgery at a university hospital in Denmark. The participants followed a predefined, interdisciplinary protocol for early intensive mobilization during the first 7 postoperative days (PODs) of their hospital admission. We evaluated feasibility in accordance with the percentage of patients who mobilized within 24 hours after surgery, mobilized at least 4 times per day and achieved daily goals of time out of bed and walking distance.
Results:
We included 48 patients with a mean age of 61 (standard deviation 17) years (48% female). Within 24 hours after surgery, 92% of the patients were mobilized and 82% or more were mobilized at least 4 times per day over the first 7 PODs. On PODs 1-3, 70%-89% of the participants achieved the daily goals of mobilization; participants still in hospital after POD 3 were less able to achieve the daily goals. Patient reported that the primary factors limiting their level of mobilization were fatigue, pain and dizziness. Participants not mobilized independently on POD 3 (28%) had significantly (p ≤ 0.04) fewer hours out of bed (4 v. 8 h), were less able to achieve the goals of time out of bed (45% v. 95%) and walking distance (62% v. 94%) and had longer hospital stays (14 v. 6 d) than participants mobilized independently on POD 3.
Conclusion:
The early intensive mobilization protocol seems feasible for most patients after AHA surgery. For nonindependent patients, however, alternative mobilization strategies and goals should be investigated.
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