Impact of early mobilization on outcomes after colorectal surgery
Notice bibliographique
Résumé
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 of a specific mobilization protocol to improve outcomes after abdominal or thoracic surgery, our observational study suggests an association between increased postoperative mobilization and improved in-hospital outcomes, which is encouraging for future research. High-quality comparative studies are needed to evaluate the impact of interventions to increase mobilization on postoperative outcomes. Results from these studies may help to guide clinicians and hospital administrators regarding the allocation of resources to this potentially resource-intensive intervention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».