Early mobilization in surgery: a narrative historical review of its evolution and contemporary implications

Early mobilization after surgery is widely recognized as a key component of enhanced recovery after surgery (ERAS) protocols, improving patient outcomes and reducing hospital stays. However, the historical roots of this practice remain insufficiently explored. This study aimed to examine the historical evolution of early mobilization from the 19th century to the mid-20th century and to reflect on its relevance for contemporary perioperative care. This study was designed as a narrative historical review based on primary historical sources, including medical articles, editorials, and case reports. Nine historical studies focusing on abdominal and pelvic surgery were included in the thematic analysis. The review identified seminal contributions such as Emil Ries' pioneering 1899 regimen and the subsequent, though intermittent, adoption of early mobilization by surgeons including Boldt and Leithauser. Initially met with resistance rooted in traditional beliefs about prolonged bed rest, early mobilization gained wider acceptance after the Second World War, as reports described reduced complications, shorter hospital stays, and improved patient well-being. Early concepts comparable to modern prehabilitation and patient engagement were also identified. This historical reconstruction suggests that early mobilization is not solely a recent innovation but part of a longer clinical trajectory. Understanding its development may help inform current surgical practice and contribute to clearer operational definitions within contemporary perioperative pathways.