L. Willcox1, J. Swinarska1, C. J. Clark1 1Wake Forest Baptist Health,Division Of Surgical Oncology,Winston Salem, NC, USA
Introduction:
Early mobilization after surgery has been shown to improve outcomes including decreased length of stay, lower postoperative morbidity, and increased patient satisfaction. However, adherence rates to Enchanced Recovery After Surgery protocols and frequency of patient ambulation during the postoperative period remain highly variable. The current study aimed to identify patient-reported barriers and facilitators for successful implementation of an inpatient exercise program after major gastrointestinal (GI) surgery.
Methods:
In this IRB-approved prospective cohort study at a large, academic, comprehensive cancer center, patients who underwent major GI surgery were identified using the electronic medical record. Eligible patients were followed postoperatively and barriers to mobilization and physical activity preferences were evaluated using a survey instrument. Additional data captured included daily ambulation frequency, clinicopathologic information, and postoperative outcomes.
Results:
40 patients (53% female, mean age 62 yrs) underwent major GI surgery with a mean length of stay of nine days. 78% of patients presented with a cancer diagnosis, the most common being upper GI malignancy. The majority of operations utilized an open approach (70%) with a mean operation time of 293 minutes and mean EBL of 341mL. Complications occurred in 48% of patients. Prior to surgery patients had a mean karnofsky performance index of 86, and the most common comorbidities included diabetes (25%), ulcer disease (17.5%), and cerebrovascular disease (7.5%). 53% of patients had a prior abdominal operation and 12.5% of patients were current smokers at the time of surgery. Eight (20%) of patients reported no regular exercise before surgery. During hospitalization, patients reported that their physical activity level was determined more by nursing (47.5%) and family encouragement (55%) and less due to the incision site (27.5%), foley catheter (24%), intravenous lines (45%), or pain level (30%). Over half (53.3%) of patients reported interest in completing a walking exercise program over a biking exercise program (26.7%) during the postoperative recovery period. Patients indicated a preference to ambulate around the hospital ward (83.3%) as opposed to walking on a treadmill (8.3%). Nearly all patients reported they could exercise more than once daily (67%), at light intensity (80%), for short time intervals (40%) preferably in the morning (80%). The majority of patients would be more compelled to exercise if it was personalized to fit their needs (93%) and recommended by their doctor (87%). Nearly all patients (93%) reported experiencing fatigue after surgery, yet no patients reported receiving education on fatigue management strategies.
Conclusion:
Family member and nursing staff encouragement are key determinates of postoperative activity for major GI surgery patients. The current study indicates patients are receptive to a postoperative exercise program that includes high frequency, short-duration, low-intensity ambulation. High-intensive treadmill or biking exercise programs are less likely to be successful.