A. Rosowicz1, J. S. Brody1, D. J. Lazar1, V. G. Bangla1, J. Dexter-Meldrum1, C. M. Divino1 1Mount Sinai School Of Medicine, General Surgery, New York, NY, USA
Introduction:
Risk of adverse events after surgery is exacerbated by physical inactivity, which negatively impacts insulin sensitivity, muscle strength, lung function, tissue oxygenation, and coagulability. The Enhanced Recovery After Surgery (ERAS) group recommends that patients spend at least two hours out of bed on the same day as surgery and six hours out of bed on each subsequent day until discharge. Although encouraging patients to ambulate as early as possible after colorectal surgery is standard of care, there is no evidence demonstrating an association between early ambulation and improved patient outcomes. The purpose of this study was to test whether early ambulation, defined here as ambulation within the first 24 hours after surgery, leads to improved outcomes following colorectal surgery and to identify any patient or procedure-related predictors of early ambulation.
Methods:
We retrospectively analyzed 276 patients who underwent a collective 291 colorectal resections from June to December 2019. The time to first ambulation after surgery was calculated and correlated with 30-day postoperative outcomes as well as various patient and procedure-related characteristics. Postoperative outcomes included length of stay, complications, returns to the ED, and readmissions. All complications were assigned scores 0 to 5 using the Clavien-Dindo (CD) classification system. We also pooled the three adverse postoperative outcomes together, creating a combined variable encompassing any complication, return to the ED, or readmission.
Results:
Following 291 procedures, 122 (41.9%) of patients ambulated within 24 hours after surgery. Patients with a history of dementia were less likely to ambulate within 24 hours (p=0.04), and patients with ASA status 2-3 ambulated earlier than patients with ASA status 4-5 (p=0.03). Patients who ambulated within 24 hours had a decreased risk of complications with CD score ≥2 (p=0.04) as well as a decreased risk of more serious complications with CD score ≥3 (p=0.02). After adjusting for ASA status, the association between early ambulation and decreased complications remained significant for the CD score ≥3 cutoff (p=0.04). Patients who did not ambulate within 24 hours were significantly more likely to return to the ED, be readmitted, or experience complications with CD score ≥2 (p=0.01) and ≥3 (p=0.02), as calculated in our combined outcome variable. These associations remained statistically significant after controlling for ASA status for both the CD score ≥2 (p=0.02) and ≥3 (p=0.03) cutoff.
Conclusion:
This study demonstrates that early ambulation leads to improved postoperative outcomes after colorectal surgery. Specifically, patients who ambulated within 24 hours postoperatively had significantly fewer adverse outcomes within 30 days. Early ambulation should be stressed in the immediate postoperative period to reduce the risk of significant clinical complications, returns to the ED, and readmissions.