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Identifying Predictors of Delayed Ambulation After Minimally Invasive Gynecologic Oncology Surgery.

Diamond Gallimore1, Atipa Nitayamekin2,3, Emily A Vertosick4

  • 1School of Medicine, University of South Carolina, Columbia, SC, USA.

Annals of Surgical Oncology
|May 14, 2026
PubMed
Summary

Early ambulation is key for surgical recovery. This study found that a higher postoperative nausea and vomiting (PONV) risk score predicts delayed ambulation in gynecologic oncology patients, regardless of antiemetic use.

Keywords:
AmbulationAmbulatory gynecologic surgeryApfel scoreEnhanced recovery after surgeryPostoperative nausea and vomiting

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Area of Science:

  • Gynecologic Oncology
  • Surgical Recovery
  • Patient Monitoring

Background:

  • Early ambulation is crucial for Enhanced Recovery After Surgery (ERAS) programs, especially for gynecologic oncology patients who face higher risks.
  • Factors influencing delayed ambulation in this population are not well understood.
  • This study utilized real-time locating systems (RTLS) for objective monitoring of ambulation.

Purpose of the Study:

  • To identify patient and procedural predictors of delayed ambulation (defined as occurring on the first postoperative day) in gynecologic oncology patients undergoing robot-assisted hysterectomy.
  • To investigate the association between postoperative nausea and vomiting (PONV) risk and delayed ambulation.

Main Methods:

  • Retrospective analysis of 1716 robot-assisted hysterectomies performed between 2016-2022.
  • Ambulation tracked using RTLS.
  • Logistic regression analysis evaluated predictors including age, BMI, fluid/opioid use, ASA class, PONV risk, operative time, blood loss, and antiemetic use.

Main Results:

  • 11% of patients experienced delayed ambulation on the first postoperative day.
  • Later surgery end time and longer operative time were significantly associated with delayed ambulation.
  • Patients with the highest PONV risk score (Apfel 4) had nearly double the odds of delayed ambulation (OR 1.94, p=0.001), independent of antiemetic prophylaxis.

Conclusions:

  • A higher PONV risk score is a significant predictor of delayed ambulation in gynecologic oncology patients post-hysterectomy.
  • Scheduling patients with high PONV risk earlier in the day may promote same-day ambulation.
  • Objective RTLS monitoring provides valuable data for understanding ambulation patterns.