M van der Leeden1, R Huijsmans2, E Geleijn2, E S M de Lange-de Klerk3, J Dekker4, H J Bonjer5, D L van der Peet5. 1. Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Rehabilitation Research Centre/Reade, Amsterdam, The Netherlands. Electronic address: m.vd.leeden@reade.nl. 2. Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands. 3. Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands. 4. Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands. 5. Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: To evaluate the feasibility and outcomes of early enforced mobilisation following surgery for gastrointestinal cancer. DESIGN: Feasibility study with a separate-sample pre-post-test design. SETTING: Surgical gastrointestinal ward. PARTICIPANTS: Patients with various types of gastrointestinal cancer, before and after implementation of postoperative enforced mobilisation (n=55 and n=61, respectively). INTERVENTION: The enforced mobilisation protocol included structured mobilisation by a nurse and walking supervised by a physiotherapist, starting within 24hours of surgery. MAIN OUTCOME MEASURES: The enforced mobilisation protocol was deemed to be feasible if at least 50% of patients were able to walk the scheduled distance on postoperative day 1. Pre- and postimplementation differences in postoperative pulmonary complications (PPCs), length of hospital stay (LOS) and re-admission rate were analysed using regression analyses, adjusting for relevant co-variables. RESULTS: In the various surgical groups, between 48% and 56% of patients were able to walk the scheduled distance on postoperative day 1, which was regarded as feasible. However, none of the patients who had undergone oesophageal resection were able to walk on postoperative day 1. Excluding these patients from the analyses, a significant decrease in PPCs was found (odds ratio 0.08, 95% confidence interval 0.010 to 0.71, P=0.023) following implementation of enforced mobilisation. Differences in LOS and re-admission rate were not significant. CONCLUSIONS: Early enforced mobilisation seems to be feasible in patients following surgery for gastrointestinal cancer, except for those undergoing oesophageal resection. The occurrence of PPCs was reduced after implementation of enforced mobilisation. Further research is needed to confirm these results.
OBJECTIVES: To evaluate the feasibility and outcomes of early enforced mobilisation following surgery for gastrointestinal cancer. DESIGN: Feasibility study with a separate-sample pre-post-test design. SETTING: Surgical gastrointestinal ward. PARTICIPANTS: Patients with various types of gastrointestinal cancer, before and after implementation of postoperative enforced mobilisation (n=55 and n=61, respectively). INTERVENTION: The enforced mobilisation protocol included structured mobilisation by a nurse and walking supervised by a physiotherapist, starting within 24hours of surgery. MAIN OUTCOME MEASURES: The enforced mobilisation protocol was deemed to be feasible if at least 50% of patients were able to walk the scheduled distance on postoperative day 1. Pre- and postimplementation differences in postoperative pulmonary complications (PPCs), length of hospital stay (LOS) and re-admission rate were analysed using regression analyses, adjusting for relevant co-variables. RESULTS: In the various surgical groups, between 48% and 56% of patients were able to walk the scheduled distance on postoperative day 1, which was regarded as feasible. However, none of the patients who had undergone oesophageal resection were able to walk on postoperative day 1. Excluding these patients from the analyses, a significant decrease in PPCs was found (odds ratio 0.08, 95% confidence interval 0.010 to 0.71, P=0.023) following implementation of enforced mobilisation. Differences in LOS and re-admission rate were not significant. CONCLUSIONS: Early enforced mobilisation seems to be feasible in patients following surgery for gastrointestinal cancer, except for those undergoing oesophageal resection. The occurrence of PPCs was reduced after implementation of enforced mobilisation. Further research is needed to confirm these results.
Authors: A E Bennett; L O'Neill; D Connolly; E M Guinan; L Boland; S L Doyle; J O'Sullivan; J V Reynolds; J Hussey Journal: Support Care Cancer Date: 2018-02-18 Impact factor: 3.603
Authors: Ross Harrison; Maria D Iniesta; Brandelyn Pitcher; Pedro T Ramirez; Katherine Cain; Ashley M Siverand; Gabriel Mena; Javier Lasala; Larissa A Meyer Journal: Int J Gynecol Cancer Date: 2020-08-26 Impact factor: 3.437
Authors: Adam E M Eltorai; Grayson L Baird; Joshua Pangborn; Ashley Szabo Eltorai; Valentin Antoci; Katherine Paquette; Kevin Connors; Jacqueline Barbaria; Kimberly J Smeals; Barbara Riley; Shyam A Patel; Saurabh Agarwal; Terrance T Healey; Corey E Ventetuolo; Frank W Sellke; Alan H Daniels Journal: Inquiry Date: 2018 Jan-Dec Impact factor: 1.730
Authors: G Nelson; A D Altman; A Nick; L A Meyer; P T Ramirez; C Achtari; J Antrobus; J Huang; M Scott; L Wijk; N Acheson; O Ljungqvist; S C Dowdy Journal: Gynecol Oncol Date: 2016-01-03 Impact factor: 5.482
Authors: Jenelle L Pederson; Raj S Padwal; Lindsey M Warkentin; Jayna M Holroyd-Leduc; Adrian Wagg; Rachel G Khadaroo Journal: PLoS One Date: 2020-11-06 Impact factor: 3.240