Current surgeon practices for postoperative activity restrictions after abdominal surgery vary widely: A survey from the communities on the ACS website

• Published in: Surgery 2020-11, Vol.168 (5), p.778-784
• Main Authors: Loor, Michele M., Dhanani, Naila H., Trautner, Barbara W., Hughes, Tyler G., Schwartz, Jerry, Wei, Qi, Liang, Mike K.
• Format: Article
• Language: English
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2020.05.035

Surgeons often impose restrictions on patient activities after an abdominal operation in an effort to prevent complications such as incisional hernia. This study addresses the current recommendations concerning the restriction of activities given by a diverse group of surgeons to their patients after abdominal surgery. A 14-item survey was posted on surgeon-specific social media platforms, primarily the American College of Surgeons Communities. This survey included questions about demographics, practice type, and activity recommendations after open and minimally invasive abdominal surgery. Descriptive, multivariable, and qualitative analyses were performed. A total of 420 surgeons completed the survey. The majority of respondents identified as general surgeons (76.2%). Practice types included private (37.6%), academic (34.3%), underserved (10.1%), and Veterans Affairs (5.6%). After an open laparotomy, the majority of respondents (53.1%) recommended that patients refrain from heavy lifting or strenuous activity for 6 weeks. For a minimally invasive abdominal operation, recommendations were even more variable, restricting activity for 2 weeks (34.4%), 4 weeks (23.8%), 6 weeks (15.5%), or no restrictions (12.6%). On average, participating surgeons recommended an earlier return to activity by 2.3 weeks for patients undergoing minimally invasive surgery compared with an open operation (95% confidence interval 2.1–2.5, P < .001). Qualitative analysis provided additional information regarding surgeons’ rationale for decision making. Only 23.8% of the respondents indicated that their recommendations were based on evidence in literature. This survey on surgeon recommendations for convalescence after an abdominal operation indicates the wide variation in practices with insufficient evidence to guide decision making. Future clinical trials examining various durations and intensities of postoperative restrictions will be important to determine a safe and patient-centered approach for recovery after an abdominal operation.