Journal Article

The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients

Padwal, Raj S., Holroyd-Leduc, Jayna M., Warkentin, Lindsey M., Pederson, Jenelle L., Wagg, Adrian, Khadaroo, Rachel G.

2020

Overview

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs . 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs . 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abdomen / Abdominal Cavity - surgery / Abdominal surgery / Activities of Daily Living / Aged / Aged, 80 and over / Appendectomy / Calculi / Canada / Cholecystectomy / Cohort analysis / Comorbidity / Death / Dentistry / Early Ambulation - methods / Early Ambulation - statistics & numerical data / Emergency medical services / Emergency medicine / Emergency Treatment - adverse effects / Female / Frailty / Health risks / Hernia / Hospitals / Humans / Intestine / Male / Medicine / Medicine and Health Sciences / Methods / Mortality / Obstructions / Older people / Patient Discharge / Patient outcomes / Patient Readmission - statistics & numerical data / Patients / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - prevention & control / Prospective Studies / Risk / Risk Assessment - statistics & numerical data / Statistical analysis / Surgery / Surgical outcomes / Surgical Procedures, Operative - adverse effects / Surgical Procedures, Operative - rehabilitation / Tertiary Care Centers - statistics & numerical data / Thoracic surgery / Time Factors / Time-to-Treatment - statistics & numerical data / Treatment Outcome