Feasibility of early postoperative mobilisation after colorectal surgery: A retrospective cohort study.

Details

Serval ID
serval:BIB_47753E21B627
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Feasibility of early postoperative mobilisation after colorectal surgery: A retrospective cohort study.
Journal
International journal of surgery
Author(s)
Grass F., Pache B., Martin D., Addor V., Hahnloser D., Demartines N., Hübner M.
ISSN
1743-9159 (Electronic)
ISSN-L
1743-9159
Publication state
Published
Issued date
08/2018
Peer-reviewed
Oui
Volume
56
Pages
161-166
Language
english
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Abstract
Enhanced Recovery After Surgery (ERAS) guidelines advocate early postoperative mobilisation to counteract catabolic changes due to immobilisation and maintain muscle strength. The present study aimed to assess compliance to postoperative mobilisation according to ERAS recommendations.
This is a retrospective cohort study on consecutive colorectal surgical procedures treated within an established ERAS protocol within a single center between May 2011 and May 2017. Demographics, surgical details, ERAS related items and surgical outcome were prospectively assessed in a dedicated database and compared between ambulant patients (at least 6 h out of bed at postoperative day (POD) 1) vs. patients not meeting the target (delayed mobilisation). Risk factors for decreased postoperative mobilisation were identified through multivariable logistic regression.
1170 patients were retained. 676 patients (58%) did not mobilise as recommended by ERAS protocol at POD1. Emergency operation (Odds Ratio (OR) 0.40; 95% Confidence Interval (CI) 0.18-0.91, p = 0.028), age > 70 years (OR 0.69; 95% CI 0.47-1.00, p = 0.050) and intraoperative total fluids > 2000 mL (OR 0.59; 95% CI 0.37-0.93, p = 0.025) were independent risk factors for delayed mobilisation. Patients with delayed mobilisation had significantly more overall (Clavien grade IV) (55% vs. 29%, p=<0.001), major (Clavien grade IIIb-V) (16% vs. 7%, p=<0.001) and respiratory (12% vs. 4%, p=<0.001) complications, as well as longer length of stay (12 ± 14 vs. 6±7days, p=<0.001).
More than half of patients did not mobilise as recommended by ERAS guidelines. Emergency surgery, advanced age and fluid overload were independent risk factors for delayed mobilisation, which was associated with increased postoperative complications.
Keywords
Adult, Aftercare/methods, Aftercare/standards, Aged, Colon/surgery, Digestive System Surgical Procedures/adverse effects, Digestive System Surgical Procedures/rehabilitation, Early Ambulation/methods, Early Ambulation/standards, Feasibility Studies, Female, Guideline Adherence, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Odds Ratio, Patient Compliance, Postoperative Complications/etiology, Postoperative Complications/prevention & control, Postoperative Period, Prospective Studies, Rectum/surgery, Retrospective Studies, Risk Factors, Treatment Outcome, Colorectal surgery, Compliance, Early ambulation, Enhanced recovery, Mobilisation
Pubmed
Web of science
Create date
29/06/2018 16:33
Last modification date
20/08/2019 13:53
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