Impact of early mobilization on outcomes after colorectal surgery
Bibliographic record
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 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".