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Title Impact of early mobilization on outcomes after colorectal surgery
Publication Date
Degree MS
Discipline/Department Department of Surgery
Degree Level masters
University/Publisher McGill University
Abstract Introduction: Early mobilization is a key aspect of postoperative care. The main benefits include prevention of the deleterious side effects of bed rest, which include venous thromboembolism, pulmonary complications, muscle wasting and physical deconditioning. Early physical activity may have many other potential benefits on different aspects of recovery after surgery, such as clinical outcomes, functional status and quality of life. The objective of the research contained within this thesis is two-fold: (1) to examine the current body of evidence regarding the impact of early postoperative mobilization protocols on outcomes after abdominal and thoracic surgery, and (2) to explore the relationship between early physical activity and specific clinical outcomes in an observational study involving patients undergoing colorectal surgery. Methods: A systematic review of the literature was performed according to the PRISMA guidelines. Eight electronic databases were searched in order to identify studies comparing patients receiving a specific protocol of early mobilization to a control group. Methodological quality was assessed using the Downs and Black tool. An observational study was subsequently carried out by conducting a secondary analysis of data from a randomized controlled trial. Sixty consecutive, adult, postoperative colorectal resection patients cared for in a multi-interventional standardized Enhanced Recovery Program were included. All patients wore an activity monitor to collect physical activity data from postoperative day (POD) 0 to POD 3, which included step counts and time spent in the standing, sitting and supine positions. Outcomes included hospital LOS, time to passage of first flatus, time to return of GI function (i.e. tolerance of solid oral intake and defecation), and serious in-hospital complications. Statistical analysis was performed using linear and logistic regression models. Results: Systematic review demonstrated that there are very few comparative studies evaluating the impact of early mobilization protocols on outcomes after abdominal and thoracic surgery, and that most of these studies were of poor quality. There were eight comparative studies that fit the review's inclusion criteria, and they reported inconsistent results regarding the impact of early mobilization protocols on postoperative complications, length of hospital stay (LOS), return of gastrointestinal (GI) function, performance-based functional outcomes and patient-reported outcomes. There is minimal literature to suggest a positive impact of early mobilization protocols on clinical, functional and health-related quality of life outcomes after abdominal and thoracic surgery. However, in our observational study, increased step counts, standing time, sitting time and non-supine time were each associated with a reduction in LOS. Increased standing time was also associated with a significant decrease in time to return of GI function. Conclusion: While systematic review of the small number of previous trials did not support the use…
Subjects/Keywords Surgery
Contributors Liane S Feldman (Internal/Supervisor)
Language en
Rights All items in [email protected] are protected by copyright with all rights reserved unless otherwise indicated.
Country of Publication ca
Format application/pdf
Record ID oai:digitool.library.mcgill.ca:141284
Other Identifiers TC-QMM-141284
Repository mcgill
Date Retrieved
Date Indexed 2019-01-09
Grantor McGill University

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