Identifying Predictors of Delayed Ambulation After Minimally Invasive Gynecologic Oncology Surgery

Early ambulation is a cornerstone of enhanced recovery after surgery (ERAS) programs, reducing pulmonary and thromboembolic complications. Gynecologic oncology patients are at particular risk, yet factors of delayed ambulation remain underexplored. Using objective monitoring from a real-time locating system (RTLS), this study examined patient and procedural predictors of delayed ambulation, defined as occurring on the first postoperative day.

The study retrospectively reviewed 2545 robot-assisted hysterectomies performed with the patient under general anesthesia between 2016 and 2022 at a high-volume, free-standing ambulatory surgical center. After exclusions, 1716 cases were analyzed. Ambulation was tracked using RTLS. Logistic regression with surgery end time (plus non-linear terms) was used to evaluate predictors of next-day ambulation, including age, body mass index, intravenous fluid, opioid use, American Society of Anesthesiologist class, postoperative nausea and vomiting (PONV) risk score, operative time, blood loss, and perioperative antiemetic use.

The median time from recovery room arrival to first ambulation was 4.8 h (interquartile range, 3.7-6.4 h), with 11 % first ambulation the next 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 double the odds of next-day ambulation compared with PONV risk ≤3 (odds ratio 1.94; 95 % confidence interval 1.31-2.86; p = 0.001). This correlation persisted after adjustment for preoperative aprepitant and intraoperative dexamethasone or ondansetron.

Higher PONV risk score predicted increased odds of next-day ambulation, independently of antiemetic prophylaxis. To facilitate ambulation within the same day of surgery, patients with high PONV risk scores may be scheduled earlier in the day.