Heather Carmichael, MD, Douglas Overbey, MD, Edward Jones, MD, Teresa Jones, MD, Carlton Barnett, John Moore, MD, Thomas Robinson, MD. University of Colorado, Denver Veteran Affairs Medical Center
Objective: Prolonged postoperative ileus increases hospital length of stay and therefore impacts healthcare costs. Although many surgeons recommend ambulation in the postoperative period to hasten return of bowel function, little evidence exists to support this practice. Our hypothesis is that early ambulation does reduce the time to return of bowel function after intestinal surgery.
Methods: A subset of 16 patients undergoing intestinal surgery from an ongoing, prospective trial evaluating perioperative physical activity was analyzed. Preoperatively, patients wore an activity tracker for a minimum of three days to establish a baseline activity level, measured by daily steps. Postoperatively, steps were recorded for 30 days. Patients were included in this study if they underwent an operation on the small bowel, colon, or rectum. Resolution of postoperative ileus was defined as the postoperative day when patients were noted to meet all of the following criteria on review of nursing documentation: passing flatus, stooling or having ostomy output, and tolerating a regular diet without intravenous fluids. “Early” postoperative activity was defined as the average number of daily steps during the first two postoperative days.
Results: Included patients had a median age of 63 years (range 49-80). Surgical procedures included laparoscopic or open partial colectomy, ileostomy reversal, low abdominal resection, and abdominoperineal resection. Patients averaged 5483 steps (range 1349-9698) at preoperative baseline and 1015 steps (range 27-3090) in the first two postoperative days. The median number of postoperative days until resolution of ileus was 4 (range 2-6).
Resolution of ileus after surgery was significantly correlated with both preoperative and postoperative steps on multiple linear regression. An increase of 1000 steps daily preoperatively was associated with a 0.44 day decrease in duration of ileus (p<0.001); similarly an increase of 1000 steps daily in the early postoperative period was associated with a decrease of 0.76 days (p<0.001). This multivariate regression produced an R2 value of 0.80 as compared to values of 0.55 and 0.39 on univariate regression of preoperative and postoperative steps, respectively.
Conclusions: Both preoperative and postoperative activity, as measured by daily steps, correlated with earlier resolution of ileus in patients undergoing intestinal surgery. The effect of early postoperative steps remained significant even when controlling for preoperative activity in a multivariate analysis. These findings support the common practice of encouraging early ambulation after surgery to hasten discharge.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86604
Program Number: P364
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster