Authors (including presenting author) :
LEE CT (1), Cheng KF (1), Wong KL (1), Lam PL (1), Cheng P (1), Tsang PL (1)
Affiliation :
(1)Physiotherapy Department, Queen Mary Hospital
Introduction :
Gastrectomy is one of the major abdominal surgeries commonly associated with post-operative decline in functional status. This deterioration of physical fitness can affect the quality of life and may delay the patient to receive other adjuvant therapies. In fact, physical activity has been shown to improve cardiopulmonary endurance and maintain a physical wellbeing. To facilitate the recovery of these patients, early mobilization is one of the major components in an ERAS pathway. This pathway for gastrectomy patients has been implemented in Queen Mary Hospital since September 2016. Meanwhile, data collection in the rehabilitation aspect has been started since February 2018.
Objectives :
1. To review the physiotherapy rehabilitation outcomes of patients after gastrectomy
2. To investigate the safety of an early postoperative mobilization after gastrectomy
Methodology :
All patients under the pathway were referred for preoperative physiotherapy assessment. Physiotherapists performed baseline mobility assessment, education on the concept of early mobilization and explanation on the expected rehabilitation process and outcomes to the patients. Ambulation aimed to be started on post-operation day 1 (POD1). Outcome measures including the types of mobility training (bed mobilization, stepping and walking exercise), numerical pain rating scale (NPRS) and the walking distance performed were documented. In addition, the duration for patients to achieve independent walking and post-operation length of stays (POLOS) were noted.
Result & Outcome :
Thirty-two patients (17 males) with a mean age of 61.3 were recruited from February 2018 to November 2020. 27 patients completed the pathway and 5 patients were excluded due to medical reasons. 93% of patients started mobility training on POD1 and more than 80% of them achieved a mean walking distance of 35m under the supervision of physiotherapists. The mean NPRS was 4.7 on POD1. Patients could resume independent ambulation and back to pre-morbid mobility status at 3.2 days after operation. Meanwhile the POLOS were 5.3 days in average. The physiotherapy compliance rate was 100% and no adverse event was reported during early mobilization.
Early mobilization in patients after gastrectomy was safe and practicable. It was associated with enhanced functional recovery. Therefore, early rehabilitation after surgery could preserve the functional status of patients after gastrectomy and is a trend of advance practice for physiotherapists.
