Early ambulation after general and digestive surgery: a retrospective single-center study
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ORIGINAL ARTICLE
Early ambulation after general and digestive surgery: a retrospective single-center study Mizuki Nishijima 1 & Hayato Baba 1 & Kenta Murotani 2 & Ryutaro Tokai 1 & Toru Watanabe 1 & Katsuhisa Hirano 1 & Kazuto Shibuya 1 & Shozo Hojo 1 & Koshi Matsui 1 & Isaku Yoshioka 1 & Tomoyuki Okumura 1 & Tsutomu Fujii 1 Received: 12 May 2020 / Accepted: 29 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Postoperative early ambulation contributes to the improvement of postoperative outcomes; however, the definition of “early” ambulation is unclear. In this study, we aimed to define desirable “early” ambulation after digestive surgery in terms of short-term outcomes and to identify the risk factors for delayed ambulation. Methods We retrospectively analyzed 718 patients who underwent major digestive surgery between January 2016 and May 2019 in our hospital. The timing of first ambulation after surgery was reviewed and correlated with short-term postoperative outcomes and perioperative patient characteristics. Results Of 718 patients, 55% underwent first ambulation at postoperative day (POD) 1, 31% at POD 2, and the remaining patients at POD 3 or later. Whereas short-term outcomes were equivalent among patients with first ambulation at POD 1 and those at POD 2, patients who delayed ambulation until POD 3 or after had an increased incidence of infectious complications (P = 0.004), longer hospitalization (P < 0.001), and a decreased home discharge rate (P < 0.001). Multivariate analysis showed that significant predictors of delayed ambulation (POD ≥ 3) were poor Eastern Cooperative Oncology Group performance status (ECOG-PS), low controlling nutritional status (CONUT), nonlaparoscopic surgery, and transvenous opioid use. Of these factors, the combination of ECOG-PS, CONUT, and nonlaparoscopic surgery clearly stratified patients into four-grade risk groups regarding delayed ambulation (P for trend < 0.001). Conclusion Our results suggest that first ambulation before POD 2 could be desirable for better short-term outcomes. Active preoperative intervention, such as nutritional care and prehabilitation, in patients with multiple risk factors for delayed ambulation could improve the postoperative course. Keywords Ambulation . Early mobilization . Digestive surgery . Malnutrition
Introduction Early mobilization is known to contribute to the reduction of complications and the improvement of the physical status in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01925-9) contains supplementary material, which is available to authorized users. * Hayato Baba [email protected] 1
Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
2
Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
the perioperative period [1], and its importance is widely recognized. In the perioperative management protocol called enh
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