Impact of Facilitation of Early Mobilization on Postoperative Pulmonary Outcomes After Colorectal Surgery

Abstract

Objective: To estimate the extent to which staff-directed facilitation of early mobilization impacts recovery of pulmonary function and 30-day postoperative pulmonary complications (PPCs) after colorectal surgery. Summary Background Data: Early mobilization after surgery is believed to improve pulmonary function and prevent PPCs; however, adherence is low. The value of allocating resources (eg, staff time) to increase early mobilization is unknown. Methods: This study involved the analysis of a priori secondary outcomes of a pragmatic, observer-blind, randomized trial. Consecutive patients undergoing colorectal surgery were randomized 1:1 to usual care (preoperative education) or facilitated mobilization (staff dedicated to assist transfers and walking during hospital stay). Forced vital capacity, forced expiratory volume in 1 second (FEV1), and peak cough flow were measured preoperatively and at 1, 2, 3 days and 4 weeks after surgery. PPCs were defined according to the European Perioperative Clinical Outcome Taskforce. Results: Ninety-nine patients (57% male, 80% laparoscopic, median age 63, and predicted FEV1 97%) were included in the intention-to-treat analysis (usual care 49, facilitated mobilization 50). There was no between-group difference in recovery of forced vital capacity [adjusted difference in slopes 0.002 L/d (95% CI −0.01 to 0.01)], FEV1 [−0.002 L/d (−0.01 to 0.01)] or peak cough flow [−0.002 L/min/d (−0.02 to 0.02)]. Thirty-day PPCs were also not different between groups [adjusted odds ratio 0.67 (0.23–1.99)]. Conclusions: In this randomized controlled trial, staff-directed facilitation of early mobilization did not improve postoperative pulmonary function or reduce PPCs within an enhanced recovery pathway for colorectal surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT02131844.

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

“…269 In clinical trials, early mobilization relieved lung atelectasis after video-assisted thoracoscopic surgery 270 and coronary artery bypass graft surgery, 271 but the effect on pulmonary complications was not significant after colorectal surgery. 272,273…”

Effect of posture on pulmonary function and oxygenation after fast-tracking video-assisted thoracoscopic surgery (VATS) lobectomy: a prospective pilot study

“…Summarising, these first data on the effect of well-defined mobilisation (change of posture from supine to sitting to standing) after fast-tracking VATS lobectomy confirms previous findings from non-ERAS open abdominal surgery with improved oxygen saturation during mobilisation (Mynster et al 1996 ). Although early mobilisation has been advocated as part of an ERAS programme from the very beginning (Kehlet 1997 ), detailed data on the degree of mobilisation are scarce (Basse et al 2002 ; Fiore Jr. et al 2017 ; Balvardi et al 2021 ). However, an early mobilisation programme with objective assessment of degree of mobilisation (step count) and aiming at 200 m walk/day by staff-assisted transfers did not find any positive outcomes at 4 weeks postop in ERAS colonic programme (Fiore Jr. et al 2017 ).…”

“…However, there was no mentioning of a potential association between pulmonary function during the mobilisation. Also, the compliance with the mobilisation programmes was not complete or analysed in detail (Balvardi et al 2021 ).…”

“…and need for oxygen support (Kaneda et al 2007 ). Consequently, the enforced early postoperative mobilisation should despite some negative long-term data from an ERAS colonic programme (Fiore Jr. et al 2017 ; Balvardi et al 2021 ) be prioritised in nursing care and studied in more detail with objective monitoring of mobilisation in VATS and other pulmonary procedures. In this context, reasons for not being mobilised should be analysed with regard to organisational vs. patient-related factors.…”

“…Although the concept of “fast-track” or “enhanced recovery” surgery (ERAS) from the beginning included early mobilisation (Kehlet 1997 ), little information is available on the effect of postural changes on pulmonary function and oxygenation in ERAS programmes including minimal invasive surgery (Balvardi et al 2021 ), despite initial observations in non-ERAS open abdominal surgery showing improved oxygen saturation when moving from supine to standing position (Mynster et al 1996 ).…”