Dataset Information

Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial.

ABSTRACT:

Background

Mobilization after emergency abdominal surgery is considered essential to facilitate rehabilitation and reduce postoperative complications. The aim of this study was to evaluate the feasibility of early intensive mobilization after acute high-risk abdominal (AHA) surgery.

Methods

We conducted a nonrandomized, prospective feasibility trial of consecutive patients after AHA surgery at a university hospital in Denmark. The participants followed a predefined, interdisciplinary protocol for early intensive mobilization during the first 7 postoperative days (PODs) of their hospital admission. We evaluated feasibility in accordance with the percentage of patients who mobilized within 24 hours after surgery, mobilized at least 4 times per day and achieved daily goals of time out of bed and walking distance.

Results

We included 48 patients with a mean age of 61 (standard deviation 17) years (48% female). Within 24 hours after surgery, 92% of the patients were mobilized and 82% or more were mobilized at least 4 times per day over the first 7 PODs. On PODs 1-3, 70%-89% of the participants achieved the daily goals of mobilization; participants still in hospital after POD 3 were less able to achieve the daily goals. Patient reported that the primary factors limiting their level of mobilization were fatigue, pain and dizziness. Participants not mobilized independently on POD 3 (28%) had significantly (p ≤ 0.04) fewer hours out of bed (4 v. 8 h), were less able to achieve the goals of time out of bed (45% v. 95%) and walking distance (62% v. 94%) and had longer hospital stays (14 v. 6 d) than participants mobilized independently on POD 3.

Conclusion

The early intensive mobilization protocol seems feasible for most patients after AHA surgery. For nonindependent patients, however, alternative mobilization strategies and goals should be investigated.

SUBMITTER: Jonsson LR

PROVIDER: S-EPMC10158751 | biostudies-literature | 2023 May-Jun

REPOSITORIES: biostudies-literature

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Publications

Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial.

Jønsson Line Rokkedal LR Foss Nicolai Bang NB Orbæk Janne J Lauritsen Morten Laksafoss ML Sejrsen Helene Nygaard HN Kristensen Morten Tange MT

Canadian journal of surgery. Journal canadien de chirurgie 20230502 3

<h4>Background</h4>Mobilization after emergency abdominal surgery is considered essential to facilitate rehabilitation and reduce postoperative complications. The aim of this study was to evaluate the feasibility of early intensive mobilization after acute high-risk abdominal (AHA) surgery.<h4>Methods</h4>We conducted a nonrandomized, prospective feasibility trial of consecutive patients after AHA surgery at a university hospital in Denmark. The participants followed a predefined, interdisciplin ...[more]

PMID: 37130709

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Project description:The aim of this study was to investigate if mobilization out of bed, within 2 hours after abdominal surgery, improved participants' respiratory function and whether breathing exercises had an additional positive effect. Participants were 214 consecutively recruited patients who underwent elective open or robot-assisted laparoscopic gynecological, urological, or endocrinological abdominal surgery with an anesthetic duration of >2 hours. They were recruited to a randomized controlled trial. Immediately after surgery, patients were randomly assigned to 1 of 3 groups: mobilization (to sit in a chair) and standardized breathing exercises (n = 73), mobilization (to sit in a chair) only (n = 76), or control (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit and continued for a maximum of 6 hours. The primary outcomes were differences in peripheral oxygen saturation (SpO2, as a percentage) and arterial oxygen pressure (PaO2, measured in kilopascals) between the groups. Secondary outcomes were arterial carbon dioxide pressure, spirometry, respiratory insufficiency, pneumonia, and length of stay. Based on intention-to-treat analysis (n = 214), patients who received mobilization and breathing exercises had significantly improved SpO2 (mean difference [MD] = 2.5%; 95% CI = 0.4 to 4.6) and PaO2 (MD = 1.40 kPa; 95% CI = 0.64 to 2.17) compared with the controls. For mobilization only, there was an increase in PaO2 (MD = 0.97 kPa; 95% CI = 0.20 to 1.74) compared with the controls. In the per-protocol analysis (n = 201), there were significant improvements in SpO2 and PaO2 for both groups receiving mobilization compared with the controls. Secondary outcome measures did not differ between groups. Mobilization out of bed, with or without breathing exercises, within 2 hours after elective abdominal surgery improved SpO2 and PaO2. The respiratory effect of mobilization (out of bed) immediately after surgery has not been thoroughly evaluated in the literature. This study shows that mobilization out of bed following elective abdominal surgery can improve SpO2 and PaO2. Mobilization within 2 hours after elective abdominal surgery, with or without breathing exercises, can improve patients' respiratory function.

Project description:ImportanceHome treatment (HT) has been associated with fewer inpatient treatment (IT) readmission days but lacks evidence on reducing combined psychiatric hospital service use (IT, HT, day clinic).ObjectiveTo assess the association of intensive home treatment (IHT) compared with IT regarding readmission rate, social outcomes, and clinical outcomes.Design, setting, and participantsThis quasi-experimental, nonrandomized trial was conducted from 2020 to 2022 in 10 psychiatric hospitals in Germany. Propensity score (PS) matching was used to compare both treatment models at the 12-month follow-up using standardized instruments and routine hospital data. All patients were screened until the target sample size was reached, based on these criteria: stable residence with privacy for sessions, no child welfare risk, primary diagnosis within International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F0X to F6X, residence in the catchment area, no commitment order, no acute suicidality or severe aggression requiring hospitalization, capacity to consent, not participating in other interventional studies, sufficient German language skills, no substantial cognitive deficits or intellectual impairment, and no more than 7 days in IHT or IT before recruitment. Statistical analysis was performed from February to November 2023.InterventionIHT provided daily acute psychiatric treatment at home, while IT was psychiatric inpatient treatment as usual. The mean treatment duration of the index treatment was 37.2 days for IHT and 28.2 days for IT.Main outcomes and measuresThe inpatient readmission rate was the primary outcome. Secondary outcomes were combined readmission rate, total inpatient days, job integration, quality of life, psychosocial functioning, symptom severity, and recovery.ResultsOf 1396 individuals, 200 patients receiving IHT and 200 patients receiving IT were included (264 female [65%]; mean [SD] age, 45.45 [15.83] years [range, 18-88 years]). Baseline sociodemographic and psychometric characteristics did not differ significantly between the groups. At 12-month follow-up, patients in the IHT group had lower inpatient readmission rate (IHT vs IT: 31.12% vs 49.74% IT; mean difference, 18% [95% CI, 9%-28%; P < .001), combined readmission rate (mean difference, 13% [95% CI, 4%-24%; P < .001), and fewer inpatient days (mean difference, 6.82 days; P < .001) than the IT group.Conclusions and relevanceThis nonrandomized clinical trial found that patients receiving IHT had a lower likelihood of utilizing hospital-based psychiatric services and spent fewer inpatient days, suggesting that IHT is a viable alternative to IT.Trial registrationClinicalTrials.gov Identifier: NCT04745507.

Dataset Information

Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial.

Background

Methods

Results

Conclusion

Publications

Early intensive mobilization after acute high-risk abdominal surgery: a nonrandomized prospective feasibility trial.

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