Guarding the Gut

Abstract

The postoperative period following abdominal surgery presents many challenges to patients and clinicians as recovery progresses and discharge from the intensive care unit approaches. Physiologic changes including the release of inflammatory mediators, increased fatigue and reduction in body mass, and a decline in pulmonary function occurring after abdominal surgery are often potentiated by bed rest and immobility. Evidence-based interventions have the potential to prevent pulmonary complications, wound instability, drain displacement, and orthostatic hypotension. Promoting early mobility is one example of an evidence-based strategy to improve patient outcomes. By understanding the specific needs of the abdominal surgery population, the clinician can safely and effectively implement a mobility plan. The purpose of this article was to briefly review the inflammatory effects associated with bed rest, critical illness, and surgery; review the literature related to mobility in the abdominal surgery patient; describe the effects of immobility on postoperative outcomes; discuss the safety concerns and barriers to mobilization; discuss strategies to overcome barriers; and provide suggestions for application in practice.

Hospital and Geographic Variability in Two Colorectal Cancer Surgery Outcomes: Complications and Mortality After Complications

“…Hospitals with higher rates of death after complications might focus on aggressive management of these high-risk complications with fluid management and early mobilization interventions. 36, 37 Greater surveillance among patients at increased risk of death following complications and rapid and appropriate intervention might increase the likelihood of survival. 38 Alternatively, hospitals could focus on preventing pulmonary and other high-mortality complications, such as interventions to reduce ventilator-assisted pneumonia.…”

The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial

“…A few studies have examined the effects of abdominal binders on CS complications (21,23,27). Some have addressed how abdominal binders impact wound healing (20,22,24) and pain medication consumption (21, 30) post-surgery.…”

“…The results of 2 studies indicated that using an abdominal binder might reduce the risk of complications by enhancing patient comfort (26,27). A study by Giller, in which the effect of abdominal binders post-CS was examined, indicated no effect on post-operative pain, perceived distress, hemoglobin, hematocrit, and extent of painkiller consumption (27). Gustafson used such a binder to relieve pain the first day post-surgery; hemoglobin and hematocrit levels were unaffected (21).…”

“…In 1 study, 94% of participants, who underwent laparotomy, wanted to use abdominal binders to prevent wound dehiscence. The results of 2 studies indicated that using an abdominal binder might reduce the risk of complications by enhancing patient comfort (26,27). A study by Giller, in which the effect of abdominal binders post-CS was examined, indicated no effect on post-operative pain, perceived distress, hemoglobin, hematocrit, and extent of painkiller consumption (27).…”

Clinical Impact of the Introduction of an Early Rehabilitation Protocol on Infectious Complications in Patients after Gastrointestinal Cancer Surgery

“…Importantly, these changes can be potentiated by prolonged bed rest. 14) In our proposed protocol, early mobilization and respiratory rehabilitation was aggressively introduced to prevent immobility and maintain pulmonary function after surgery. The protocol may have been beneficial in preventing such harmful physiological changes.…”