Factors influencing early mobilisation for patients undergoing pancreatic surgery from multiple perspectives: a qualitative descriptive study

Ni, Yun-Xia; Li, Zhi; Zhou, Li-Li; Gong, Shu

doi:10.1136/bmjopen-2023-077419

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…Despite a significant proportion of parturients having their urinary catheter removed before the 12th postoperative hour, the study suggests a need for protocol refinement to prevent the negative impacts of prolonged catheterization (12). Similarly, while our findings did not demonstrate an early removal of the venous line within the initial 24 hours, they indicated a trend towards maintaining a functional occluded catheter, emphasizing the importance of such practices in facilitating early rehabilitation (13,14). Mobility post-caesarean section, pivotal for preventing thromboembolic venous disease and minimizing hospital stay durations, revealed that a majority of parturients initiated mobilization before the 12th postoperative hour.…”

Section: Discussioncontrasting

confidence: 62%

Post-Caesarean Rehabilitation: Evaluation Of Practices

Kamel,

Cyrine,

Hayene

2024

JHRR

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Background: Early Rehabilitation, "Fast-Track Surgery," or Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in various surgical procedures, including caesarean sections. These protocols aim to expedite recovery, reduce hospital stays, and minimize complications through a multidisciplinary approach. Despite their proven effectiveness, the implementation of such protocols in post-caesarean recovery remains uneven and warrants further investigation. Objective: This study aims to evaluate the current practices of early post-caesarean rehabilitation, focusing on pain management, early nutritional intake, mobilization, and mother-child bonding to identify gaps and opportunities for improvement. Methods: A prospective observational multicenter study was conducted between January and April 2021 at the Maternity and Neonatology Center of Tunis and the Principal Military Hospital of Tunis. The study involved 170 parturients undergoing caesarean section under spinal anesthesia, excluding those with contraindications. Data were collected using a standardized form, covering demographic details, medical history, surgical and anesthesia details, and post-operative recovery metrics, including pain assessment (VAS scores), timing of first oral intake, mobilization, and mother-child bonding. Statistical analysis was performed using SPSS version 25. Results: The average age of parturients was 30 ± 5 years. A majority (73%) of caesarean sections were planned, with surgery durations mostly within one to two hours. Post-operative pain management revealed that 73% of parturients reported a VAS ≤ 2 at the 3rd hour, but 77% experienced a VAS ≥ 4 by the 6th hour. Early oral intake was initiated by 66% of parturients before the 6th hour for liquids and before the 12th hour for light meals. The urinary catheter was removed before the 12th postoperative hour in 56% of cases. Early mobilization was achieved by 67% of parturients before the 12th hour, and 82% were breastfeeding naturally, with 79.7% satisfaction with care. Conclusion: The study highlights the partial implementation of ERAS protocols in post-caesarean recovery, pinpointing areas for improvement, particularly in pain management, early oral intake, and mobilization. A standardized approach to early post-caesarean rehabilitation could significantly enhance maternal and neonatal outcomes, reduce complications, and improve patient satisfaction.

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Section: Discussioncontrasting

confidence: 62%

Post-Caesarean Rehabilitation: Evaluation Of Practices

Kamel,

Cyrine,

Hayene

2024

JHRR

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A Closed-Loop Audit of Early Mobilization of Thoracic Surgery Patients on Postoperative Day 0

Demirtas,

Brookes

2024

Cureus

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Introduction Early mobilization in the postoperative period, particularly on the day of surgery, is crucial for reducing morbidity and mortality in thoracic surgery patients. Starting physical activity as soon as clinically feasible enhances recovery and is a key component of enhanced recovery pathways. Effective implementation of early mobilization protocols requires collaboration among multidisciplinary teams (MDT), emphasizing its importance in postoperative care. This audit evaluates adherence to early mobility protocols for thoracic surgery patients at Queen Elizabeth Hospital, Birmingham (QEHB), focusing on mobilization rates on postoperative day 0 (POD-0) in line with the Enhanced Recovery After Surgery (ERAS) guidelines. It also aims to identify barriers to optimal practice and improve current practice through targeted interventions, including MDT training and posters to enhance healthcare professionals' adherence. Methods This closed-loop audit at QEHB targeted thoracic surgery patients from November 2023 to June 2024. Data collection occurred in three cycles: the first from November to December 2023 (60 patients), the second from February to March 2024 (59 patients), and the third from May to June 2024 (39 patients). Retrospective data were collected using an electronic documentation system, capturing demographic and clinical variables, including age, sex, preoperative mobility, comorbidities, and surgical details. The primary outcomes assessed were POD-0 mobilization rates and mobility levels achieved. Interventions included MDT training on ERAS guidelines and reminder posters for doctors. Data were analyzed by using descriptive statistics for demographic and clinical variables. Additionally, regression analysis was performed to assess the impact of interventions on mobilization rates on POD-0. Results Pre-intervention data showed that only 30% (n=18) of patients mobilized on POD-0. Ward patients had a 44% (n=15) mobilization rate, while rates were lower in the high dependency unit (HDU) and enhanced post-operative care (EPOC) at 16.7% (n=3) and 0% (n=0), respectively. After two interventions (MDT training and posters), mobilization on POD-0 increased to 45.8% (n=27) and 67.6% (n=25) in subsequent cycles. Among ward patients mobilization on POD-0 increased to 94.1% (n=16), while HDU patients improved to 55.5% (n=5). Additionally, it varied by surgical approach, with robotic-assisted thoracoscopic surgery (RATS) patients rising from 30% (n=6) to 45.5% (n=15) and video-assisted thoracoscopic surgery (VATS) patients increasing from 23.8% (n=5) to 81.8% (n=9) at the end of the third cycle. Patients mobilizing on POD-0 had a shorter median length of stay (two days; interquartile range (IQR)=3) compared to those who did not (five days; IQR=5). Confounding factors were not considered, so no causal conclusions should be drawn. Conclusion This audit demonstrates the successful implementation of early mobilization proto...

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Factors influencing early mobilisation for patients undergoing pancreatic surgery from multiple perspectives: a qualitative descriptive study

Cited by 2 publications

References 47 publications

Post-Caesarean Rehabilitation: Evaluation Of Practices

Post-Caesarean Rehabilitation: Evaluation Of Practices

A Closed-Loop Audit of Early Mobilization of Thoracic Surgery Patients on Postoperative Day 0

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