Evaluation of an enhanced recovery after lung surgery (ERALS) program in lung cancer lobectomy: An eight-year experience

Early mobilization after anatomical lung resection with thoracotomy

In the past, patients who underwent thoracic surgery were advised to rest, recover, and save energy, avoiding engaging in tiring physical activity. Postoperative rest-centered management of patients following anatomical resection can cause pulmonary and cardiovascular complications. Inability to cough, not deep breathing, dysfunctional diaphragm, pain and lying down cause lung atelectasis, pneumonia, and respiratory failure. Early postoperative mobilization's effects on mental or physical recovery and morbidity rate are unclear. Although advanced technological developments, thoracotomy is still the main incision for thoracic surgery. Lung resection and thoracotomy reduce the quality of patients' daily ambulatory activities. The exercise was shown to have anti-inflammatory effects. Anxiety, fear, and pain activate the same brain regions. Postoperative early mobilization could reduce anxiety and help to reduce the intensity of pain. Many different procedures that stop bed rest, start mobilization, and the walking distance or number of steps during postoperative the first mobilization are applied in the departments of thoracic surgery. How many meters the patient can walk and how many steps he/she needs to take are variable. Protocols to facilitate and enforce early mobilization would be beneficial. Early mobilization can reduce the rate of postoperative complications and length of hospital. Early mobilization as soon as possible within the first 24 h is supported as safe and acceptable in literature.

Why Didn't You Walk Yesterday? Factors Associated With Slow Early Recovery After Adult Spinal Deformity Surgery

STUDY DESIGN

This is a retrospective case-control study.

OBJECTIVES

The objectives of this study are to identify (1) risk factors for delayed ambulation following adult spinal deformity (ASD) surgery and (2) complications associated with delayed ambulation.

METHODS

One-hundred and ninety-one patients with ASD who underwent posterior-only fusion (≥5 levels, LIV pelvis) were reviewed. Patients who ambulated with physical therapy (PT) on POD2 or later (LateAmb, n = 49) were propensity matched 1:1 to patients who ambulated on POD0-1 (NmlAmb, n = 49) based on the extent of fusion and surgical invasiveness score (ASD-S). Risk factors, as well as inpatient medical complications were compared. Logistic regressions were used to identify risk factors for late ambulation.

RESULTS

Of the patients who did not ambulate on POD0-1, 32% declined participation secondary to pain or dizziness/fatigue, while 68% were restricted from participation by PT/nursing due to fatigue, inability to follow commands, nausea/dizziness, pain, or hypotension. Logistic regression showed that intraoperative estimated blood loss (EBL) >2L (OR = 5.57 [1.51-20.55], P = .010) was independently associated with an increased risk of delayed ambulation, with a 1.25 times higher risk for every 250 mL increase in EBL (P = .014). Modified 5-Item Frailty Index (mFI-5) was also independently associated with delayed ambulation (OR = 2.53 [1.14-5.63], P = .023). LateAmb demonstrated a higher hospital LOS (8.4 ± 4.0 vs 6.2 ± 2.6, P < .001). The LateAmb group trended toward an increase in medical complications on POD3+ (14.3% vs 26.5%, P = .210).

CONCLUSIONS

EBL demonstrates a dose-response relationship with risk for delayed ambulation. Delayed ambulation increases LOS and may impact medical complications.