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Early identification of patients at risk for delayed recovery of ambulation after elective abdominal surgery

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Abstract

Background

Recovery of preoperative ambulation levels 1 month after surgery represents an important patient-centered outcome. The objective of this study is to identify clinical factors associated with the inability to regain baseline preoperative ambulation levels 28 days postoperatively.

Methods

This is a prospective cohort study enrolling patients scheduled for elective inpatient abdominal operations. Daily ambulation (steps/day) was measured with a wristband accelerometer. Preoperative steps were recorded for at least 3 full calendar days before surgery. Postoperatively, daily steps were recorded for at least 28 days. The primary outcome was delayed recovery of ambulation, defined as inability to achieve 50% of preoperative baseline steps at 28 days postoperatively.

Results

A total of 108 patients were included. Delayed recovery (< 50% of baseline preoperative steps/day) occurred in 32 (30%) patients. Clinical factors associated with delayed recovery after multivariable logistic regression included longer operative time (OR 1.37, 95% CI 1.05–1.79), open operative approach (OR 4.87, 95% CI 1.64–14.48) and percent recovery on POD3 (OR 0.73, 95% CI 0.56–0.96). In addition, patients with delayed ambulation recovery had increased rates of postoperative complications (16% vs 1%, p < 0.01) and readmission (28% vs 5%, p < 0.01).

Conclusion

After elective inpatient abdominal operations, nearly one in three patients do not recover 50% of their baseline preoperative steps 28 days postoperatively. Factors that can be used to identify these patients include longer operations, open operations and low ambulation levels on postoperative day #3. These data can be used to target rehabilitation efforts aimed at patients at greatest risk for poor ambulatory recovery.

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Funding

This work was funded by a 2018 grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

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Authors and Affiliations

  1. Department of Surgery, University of Colorado, Aurora, CO, USA

    Alexandra Kovar, Heather Carmichael, Teresa S. Jones, Christina M. Goode, Douglas M. Overbey, Edward L. Jones & Thomas N. Robinson

  2. Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 North Wheeling ST, Mail Stop 112, Aurora, CO, 80045, USA

    Teresa S. Jones, Edward L. Jones & Thomas N. Robinson

  3. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA

    Patrick Hosokawa

  4. Rocky Mountain Regional Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA

    Teresa S. Jones

Authors
  1. Alexandra Kovar
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  2. Heather Carmichael
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  3. Teresa S. Jones
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  4. Patrick Hosokawa
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  5. Christina M. Goode
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  6. Douglas M. Overbey
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  7. Edward L. Jones
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  8. Thomas N. Robinson
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Contributions

HC, DO and TR contributed to the research conception and design. HC, DO, CG, TJ, EJ and TR Contributed to acquisition of data. HC, PH, CG and TR completed all data analysis and complication of the data. AK, HC, PH, EJ, TJ and TR contributed to writing and critical revision of the article.

Corresponding author

Correspondence to Teresa S. Jones.

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Disclosures

Dr Heather Carmichael and Thomas Robinson received a 2018 SAGES Research Grant for this study. No study number was assigned. Drs Alexandra Kovar, Teresa Jones, Douglas Overbey and Edward Jones have no conflicts of interest or financial ties to disclose. Patrick Hosokawa and Christina Goode have no conflicts of interest or financial ties to disclose.

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Kovar, A., Carmichael, H., Jones, T.S. et al. Early identification of patients at risk for delayed recovery of ambulation after elective abdominal surgery. Surg Endosc 36, 4828–4833 (2022). https://doi.org/10.1007/s00464-021-08829-9

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  • DOI: https://doi.org/10.1007/s00464-021-08829-9

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