Effects of early postoperative mobilization following gastrointestinal surgery: systematic review and meta-analysis

Abstract

Background Early postoperative mobilization is considered a key element of enhanced recovery after surgery protocols. The aim of this study was to summarize the effect of early postoperative mobilization following gastrointestinal operations on patient recovery, mobility, the morbidity rate and duration of hospital stay. Methods A systematic literature search was conducted in December, 2022, using PubMed, Web of Science and the Cochrane Central Register of Controlled Trials. Controlled trials reporting the effects of early postoperative mobilization after gastrointestinal surgery were included. The risk of bias was assessed using a modified Downs and Black tool and the Cochrane Collaboration tool for randomized trials. The outcomes of interest were gastrointestinal recovery (defined passage of first flatus or bowel movements), mobility (step count on postoperative day 3), the morbidity rate and duration of hospital stay. Results After elimination of duplicates, 3678 records were identified, and 71 full-text articles were screened. Finally, 15 studies (eight RCTs) reporting on 3538 patients were included. Most trials evaluated early postoperative mobilization after different gastrointestinal operations, including upper gastrointestinal (n = 8 studies), hepatopancreatobiliary (n = 10 studies) and colorectal resections (n = 10 studies). The investigated early postoperative mobilization protocols, operative techniques (minimally invasive or open) and outcome parameters were heterogeneous between the studies. Early postoperative mobilization seemed to significantly accelerate clinical gastrointestinal recovery (mean difference, hours: −11.53 (−22.08, −0.97), P = 0.03). However, early postoperative mobilization did not significantly improve the morbidity rate (risk ratio: 0.93 (0.70, 1.23), P = 0.59), postoperative mobility of patients (step count mean difference: 1009 (−803, 2821), P = 0.28) or shorten the duration of hospital stay (mean difference, days: −0.25 (−0.99,0.43), P = 0.47) in randomized trials. Conclusion There is a large heterogeneity among the study cohorts, operations and interventions. The available evidence currently does not support specific early postoperative mobilization protocols as an isolated element to further reduce the morbidity rate and duration of hospital stay. Further well-designed trials are required to identify effective early postoperative mobilization protocols.

Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial

“…26 The absence of a meaningful impact of our study on postoperative complications is in contrast to previous experiences, [2][3][4] but in line with some recent systematic reviews of randomised controlled trials assessing specific ERAS items, as prehabilitation 27 and early mobilisation interventions. 28 According to a Cochrane systematic review of the efficacy of A&F 22 in modifying healthcare behaviours, the global change in compliance observed in the present study can be considered a relevant result. Specific comparisons with previous experiences of ERAS implementation are not easy because it is not clear whether and how explicit A&F interventions were adopted.…”

“…The absence of a meaningful impact of our study on postoperative complications is in contrast to previous experiences, 2–4 but in line with some recent systematic reviews of randomised controlled trials assessing specific ERAS items, as prehabilitation 27 and early mobilisation interventions. 28 …”

Navigating Perioperative Challenges in Pott’s Spine: A Comprehensive Review

“…The research underscores that insufficient postoperative analgesia can impede mobilization, underscoring the necessity of managing pain effectively to facilitate early mobilization post-surgery [31,32]. Early mobilization following gastrointestinal surgery has been associated with a spectrum of benefits, including hastened gastrointestinal recovery, diminished postoperative pain intensity, improved sleep quality, and reduced incidence of fatigue [33]. Moreover, early mobilization protocols have been correlated with shorter hospital stays in certain studies, highlighting the favorable impact of mobilization on postoperative outcomes [33].…”

“…Early mobilization following gastrointestinal surgery has been associated with a spectrum of benefits, including hastened gastrointestinal recovery, diminished postoperative pain intensity, improved sleep quality, and reduced incidence of fatigue [33]. Moreover, early mobilization protocols have been correlated with shorter hospital stays in certain studies, highlighting the favorable impact of mobilization on postoperative outcomes [33]. In postoperative pain management, providing adequate analgesia is paramount for patient comfort and fostering early mobilization, a cornerstone of enhanced recovery after surgery initiatives [34,35].…”

Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

“…This approach is applicable to a wide range of surgical procedures, including abdominal surgeries, joint replacements, and other interventions. However, as an isolated element to reduce the morbidity rate and duration of hospital stay, early mobilization alone failed to help enhanced recovery 62 , 63 . Then, this prescription should be associated with other elements of ERPs.…”