The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review

Castelino, Tanya; Fiore, Julio F.; Niculiseanu, Petru; Landry, Tara; Augustin, Berson; Feldman, Liane S.

doi:10.1016/j.surg.2015.11.029

Cited by 182 publications

(150 citation statements)

References 35 publications

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“…40,41,43,[47][48][49] Therefore, intervention strategies, such as early mobilization and more intensive mobilization, should be prioritized for elderly patients. A recent systematic review by Castelino and colleagues 16 reports little available evidence to guide clinicians in strategies of early mobilization following abdominal and thoracic surgery. This reveals the need for studies investigating the effect of early and standardized mobilization in patients following AHA surgery in association with physical performance.…”

Section: Physical Performancementioning

confidence: 99%

“…Evidence suggests that early mobilization may reduce the incidence of pulmonary complications after abdominal surgery, but there is limited knowledge on the frequency and intensity of mobilization needed to achieve this outcome. 16,19,52,[54][55][56] This reveals the importance of interventions aimed at reducing the risk of postoperative pulmonary complications, where early mobilization and respiratory therapy could play a role.…”

Section: Physical Performancementioning

confidence: 99%

“…8,10,12 Early mobilization and exercise are known to play important roles in postoperative care following abdominal surgery and are associated with less postoperative reduction of fitness and fewer postoperative complications in patients undergoing elective surgery. 9,[15][16][17][18][19][20] There are, to our knowledge, no published data on postoperative physical performance, level of 24-hour physical activity, or barriers to independent mobilization within the first week following AHA surgery. Such findings are crucial when organizing strategies for enhanced recovery programs after AHA surgery.…”

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confidence: 99%

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Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

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Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods:Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion:Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour amélio-rer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7).Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes.Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de c...

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Section: Physical Performancementioning

confidence: 99%

Section: Physical Performancementioning

confidence: 99%

mentioning

confidence: 99%

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Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

cjs

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“…Early mobilization is regarded important (Bakhru et al, 2015) and is a common part of early recovery pathways after surgery (de Groot et al, 2016;Day et al, 2015). What affects early postoperative mobilization is multifactorial, which need further investigation, and our input might go some way to explain why tests of early mobilization programs give mixed results (Castelino et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

How Communication Disharmonies between Patients and Nurses Can Affect Patients—A Qualitative Study of Illness Experienced from the Patients View

Thygesen¹,

Pedersen²

2017

PSYCH

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Patient-provider interaction is important for cancer patients' wellbeing and further coping and it might be beneficial to further investigate this in the fast track trajectories. Cancer patients experience themselves as liminal and we aimed to investigate how patients experience healthcare professionals' attitude with regard to the patients' own illness experience. Diaries, observation notes, and an elicitation technique supported in the semi-structured interview situations with eight female patients few days after discharge after gynecological cancer surgery were used. Data were transcribed verbatim and analyzed using a Ricoeur inspired technique, which started open-minded. Situations with harmony between patients' experience of their health state and nurses' signals in this regard were more peaceful and energizing for the patients than situations with disharmony, which gave limbo experiences and drained of energy. The Broaden and Build theory and the Sense of Coherence theory might support our findings. True presence of the nurse is important in order to meet the patient where she is and communicate from there. More evidence based suggestions for future clinical foci are given. Female cancer patients can be vulnerable to healthcare professionals' small signals regarding the patients' state of health, and harmony or disharmony between these signals and patients' own experiences means a difference to their psychological wellbeing. It might also mean a difference to early mobilization.

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“…Early mobilization is an important aspect of postoperative care, to be encouraged by all the team. There is limited evidence on which protocol to adopt [35 ▪ ], but the patient who can mobilize quickly becomes an active participant in their care [36]. This might again reduce postoperative complications and risk of prolonged stay or readmission.…”

Section: Case #1: Listed For Surgical Resectionmentioning

confidence: 99%

Practical multimodal care for cancer cachexia

Maddocks

Hopkinson

Conibear

et al. 2016

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewCancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory.Recent findingsFour cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments.SummaryWe demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

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The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review

Cited by 182 publications

References 35 publications

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

How Communication Disharmonies between Patients and Nurses Can Affect Patients—A Qualitative Study of Illness Experienced from the Patients View

Practical multimodal care for cancer cachexia

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