Immediate mobilization in post‐anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double‐blinded controlled trial within an enhanced recovery protocol

• Published in: World journal of surgery 2024-04, Vol.48 (4), p.956-966
• Main Authors: Wilnerzon Thörn, Rose‐Marie, Forsberg, Anette, Stepniewski, Jan, Hjelmqvist, Hans, Magnuson, Anders, Ahlstrand, Rebecca, Ljungqvist, Olle
• Format: Article
• Language: English
• Subjects: Adolescent; Aged; Anesthesia; Colorectal Surgery; Digestive System Surgical Procedures; early mobilization; enhanced recovery after surgery; Exercise; Female; Humans; Length of Stay; Male; Postoperative Complications - prevention & control; randomized clinical trial; Randomized Controlled Trials as Topic; Robotic Surgical Procedures
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1002/wjs.12102

Background The level of post‐operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post‐anesthesia care unit (PACU) compared to standard care. Methods This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1–3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery. Results With the intention‐to‐treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic‐or robotic‐assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75–1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68–1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69–1.17], p = 0.44); no differences were found in any of the other outcome measures. Conclusions Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay. Trial registration ClinicalTrials.gov Identifier: NTC 03357497.