Background The Enhanced Recovery After Surgery (ERAS) society lists early mobilization as one of their recommendations for improving patient outcomes following colorectal surgery. The level of supporting evidence, however, is relatively weak, and furthermore, the ERAS guidelines do not clearly define “early” mobilization. In this study, we define mobilization in terms of time to first ambulation after surgery and develop an outcome-based cutoff for early mobilization. Methods This is a retrospective cohort study comprised of 291 patients who underwent colorectal operations at a large, academic medical center from June to December 2019. Three cutoffs (12 hours, 24 hours, and 48 hours) were used to divide patients into early and late ambulation groups for each cutoff, and statistical analysis was performed to determine differences in postoperative outcomes between the corresponding groups. Results Multivariate analysis showed no difference between the early and late ambulation groups for the 12-hour and 48-hour cutoffs; however, ambulation before 24 hours was associated with a decreased rate of severe complications as well as fewer adverse events overall. Patients who ambulated within 24 hours had a 4.1% rate of severe complications and a 22.1% rate of experiencing some adverse event (complication, return to the emergency department, and/or readmission). In comparison, 11.8% of patients who ambulated later experienced a severe complication ( P = 0.026), while 36.1% of patients experienced some adverse event ( P = 0.011). Conclusions Ambulation within 24 hours after colorectal surgery is associated with improved postoperative outcomes, particularly a decreased rate of severe complications.

Background: Cardiovascular disease is the leading cause of death among patients with autosomal dominant polycystic kidney disease (ADPKD). Smoking increases inflammation and contributes to cardiovascular disease in the general population. The purpose of this study was to determine the effects of smoking on health outcomes in patients with ADPKD. Methods: The study population included 350 smoking and 371 non-smoking ADPKD patients who participated in studies at the University of Colorado between 1985 and 2001. In addition, outcome data collected between 2011 and 2012 by survey from 159 smoking and 259 non-smoking ADPKD patients was analyzed. The frequency of cardiovascular or cerebrovascular events, age at onset of end stage renal disease, and serum and urine chemistries where available were compared in smoking and non-smoking patients. Serum levels of soluble CD40 ligand measured by ELISA were analyzed in a subset of 40 patients matched by age, sex, and renal function. Results: ADPKD smokers from the University of Colorado study cohort had more cardiovascular events and higher urinary protein excretion than ADPKD non-smokers. The ADPKD survey respondents had a higher rate of cerebrovascular events in patients who smoked. Smoking years were associated with increased odds of having a cerebrovascular event. Serum soluble CD40 ligand level was higher in ADPKD patients who smoked compared to non-smoking patients (5293 ± 3168 vs. 3285 ± 2169 pg/mL, P=0.025) indicative of increased inflammation. Conclusions: ADPKD patients who smoke have a higher hazard for cardiovascular and cerebrovascular events and evidence for increased inflammation.

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