Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio; Department of Anesthesia, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio; Division of Anesthesia, Critical Care and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Anesthesiology. 2022 Jan 1;136(1):115-126. doi: 10.1097/ALN.0000000000004037.
Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications.
The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing.
A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009).
Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly.
早期活动已纳入许多加速康复路径中。镇痛不足或阿片类药物使用过量可能会限制术后活动。作者检验了如下假设：在接受腹部手术后恢复的成年人中，术后疼痛和阿片类药物的使用与术后活动呈负相关，而术后活动与较少的潜在相关并发症有关。
作者对两项纳入腹部手术后恢复成年人的试验进行了亚组分析。使用非侵入性无绳监测器连续监测 48 小时的术后姿势和运动。活动度定义为监测时间内坐立或站立的时间比例。
共有 673 名患者在监测时间内平均[四分位数范围]有 7%[3 至 13%]的时间处于坐立或站立状态。平均疼痛评分为 3 分或更低的患者，活动时间为 1.9[1.0 至 3.6]小时/天，而平均疼痛评分为 6 分或更高的患者仅为 1.2[0.5 至 2.6]小时/天。平均疼痛评分每增加 1 个单位，活动时间就会减少 0.12（97.5%CI，0.02 至 0.24；P = 0.009）小时/天。相比之下，术后阿片类药物使用量与活动时间之间无关联。在低活动组中，术后并发症的复合发生率为 6.0%（10/168），第二组为 4.2%（7/168），而在活动时间最长的两个四分位数的 337 名患者中则为 0%（P = 0.009）。
接受腹部手术的患者仅活动了 7%的时间，远低于推荐的活动时间。较低的疼痛评分与活动度增加有关，与阿片类药物的使用无关。活动较差的患者并发症更常见。
