M. W. LaPorta1, E. T. Wills1, A. W. Trickey1, P. Graling1, D. B. Colvin1, J. J. Moynihan1, H. D. Reines1 1Inova Fairfax Hospital,Department Of Surgery,Falls Church, VA, USA
Introduction
The importance of early postoperative ambulation has been recognized for decades. Early ambulation is associated with decreased venous thromboembolism (VTE), atelectasis, urinary retention, and length of stay, as well as increased patient satisfaction, improved pain control and return of bowel function. Patients deserve to be active participants in facilitating a safe and swift postoperative recovery. We focused on an early ambulation initiative to reduce postoperative VTE in the colorectal surgery population.
Methods:
Patients ≥18 years of age undergoing elective procedures from one large private colorectal surgery practice were enrolled from October 2014-March 2015. Starting at the pre-surgical visit and continuing in the pre-operative area, patients were educated on the importance of early ambulation on recovery after surgery. Post-anesthesia care unit (PACU) nursing and staff ambulated patients 100 feet within 1 hour of reaching PACU. An interim analysis using retrospective chart review from the Electronic Medical Record and Premier Quality Database compared patient outcomes 6 months pre-implementation versus 6 months post-implementation; outcomes were compared overall then stratified among patients receiving open, laparoscopic, or robotic-assisted procedures. Chi-square or Fisher’s exact tests were calculated with an intent-to-treat analysis. All patients meeting inclusion criteria in the post-ambulation period were included in the analysis, regardless of ambulation status.
Results:
A total of 72 /279 (25.8%) patients successfully ambulated in the PACU. The mean ambulation distance was 128 feet. Team members overcame skepticism related to the safety of this endeavor and the constraints of limited available time for ‘bedside nursing’ by engaging all key stakeholders including: patients and families, perioperative nursing staff, anesthesia services, and the surgical team. Characteristics of pre-implementation patients (N=279) were similar to post-implementation (N=228), including age, body mass index, fall risk scores, surgeons, and procedure types. During the first 6 months of the colorectal mobility initiative, there were no postoperative VTE occurrences, compared to 5 VTE events pre-implementation. Although this reduction does not reach statistical significance, it represents a clinically meaningful improvement and a strong trend (1.8% vs. 0%, p=0.07). Postoperative infections were reduced from 29% to 23% (p=0.09), with a significant infection reduction in laparoscopic procedures (28% vs. 14%, p=0.05).
Conclusion:
Results of the mobility initiative demonstrate that early postoperative ambulation can be accomplished safely. While the observed VTE reduction has not yet achieved statistical significance, meaningful trends have emerged in decreasing VTE and surgical site infections. Large-scale implementation and further evaluation is ongoing at our institution to determine if the trend will continue.