Background The Enhanced Recovery After Surgery (ERAS) society lists early mobilization as one of their recommendations for improving patient outcomes following colorectal surgery. The level of supporting evidence, however, is relatively weak, and furthermore, the ERAS guidelines do not clearly define “early” mobilization. In this study, we define mobilization in terms of time to first ambulation after surgery and develop an outcome-based cutoff for early mobilization. Methods This is a retrospective cohort study comprised of 291 patients who underwent colorectal operations at a large, academic medical center from June to December 2019. Three cutoffs (12 hours, 24 hours, and 48 hours) were used to divide patients into early and late ambulation groups for each cutoff, and statistical analysis was performed to determine differences in postoperative outcomes between the corresponding groups. Results Multivariate analysis showed no difference between the early and late ambulation groups for the 12-hour and 48-hour cutoffs; however, ambulation before 24 hours was associated with a decreased rate of severe complications as well as fewer adverse events overall. Patients who ambulated within 24 hours had a 4.1% rate of severe complications and a 22.1% rate of experiencing some adverse event (complication, return to the emergency department, and/or readmission). In comparison, 11.8% of patients who ambulated later experienced a severe complication ( P = 0.026), while 36.1% of patients experienced some adverse event ( P = 0.011). Conclusions Ambulation within 24 hours after colorectal surgery is associated with improved postoperative outcomes, particularly a decreased rate of severe complications.

Background A few important risk factors play into rates of perforation following acute appendicitis. Diabetes may be an additional risk factor due to various systemic complications that may contribute to perforation and additional adverse outcomes following acute appendicitis, all of which currently remains unknown in the United States. Methods Adult patients with acute appendicitis under 65 years of age were identified from the National Inpatient Sample between 2012 and 2014 and the distribution of baseline variables was examined across diabetic status using Rao-Scott chi square and student’s t-test. A propensity score match was implemented for a conditional logistic regression that assessed differences in rates of perforation, outcomes, as well as postoperative complications. Results Among all patients with acute appendicitis, approximately 7% had diabetes. Diabetics were more likely to experience perforated appendicitis (odds ratio 95% confidence interval 1.093 (1.029, 1.160); P = .0036), experience a longer length of stay (1.540 (1.434, 1.654); P < .0001), receive an open appendectomy (1.139 (1.05, 1.236); P = .0018), and experience postoperative cardiovascular complications (2.103 (1.325, 3.340)); P = .0016). Discussion Diabetic adult patients under 65 years of age with acute appendicitis experience higher rates in perforation, a longer length of stay, more open surgical approach, and cardiovascular postoperative complications. Diabetes should be one of many risk factors considered in the evaluation and management of perforation following acute appendicitis.

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