Early Mobilization Strategies

Early Mobilization: Intro - Get Moving, Get Better!

• Definition: A cornerstone of ERAS, involving planned, progressive physical activity initiated as soon as feasible post-surgery, typically within 24 hours.
• Rationale: Actively counteracts physiological deconditioning and the surgical stress response, mitigating effects of prolonged bed rest.
• Primary Goals:
  • Accelerate functional recovery.
  • Reduce postoperative complications:
    • Pulmonary: ↓ atelectasis, pneumonia.
    • Vascular: ↓ Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE).
    • Gastrointestinal: ↓ postoperative ileus.
  • Shorten hospital Length Of Stay (LOS).
  • Enhance patient well-being.

⭐ Early mobilization is a critical ERAS component, proven to decrease overall postoperative morbidity (e.g., VTE, infections) and accelerate recovery.

Early Mobilization: Benefits - Mobilization Mojo

• Systemic Physiological Gains:
  • Lungs: ↓ Atelectasis, ↓ risk of pneumonia, improved ventilation/perfusion (V/Q) matching.
  • Heart & Vessels: ↓ Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) incidence, ↓ orthostatic hypotension, enhanced venous return.
  • Muscles & Bones: Preserves muscle mass & strength, ↑ joint mobility, ↓ fatigue.
  • Gut: Promotes peristalsis, ↓ duration of postoperative ileus.
  • Metabolic: ↑ Insulin sensitivity, ↓ catabolic stress response, improved glucose control.
• Key Clinical Outcomes:
  • Reduced Length of Hospital Stay (LOS).
  • ↓ Overall postoperative complications (e.g., surgical site infections, VTE).
  • Improved patient-reported outcomes & satisfaction.
  • Quicker return to baseline functional status & daily activities.

⭐ Early mobilization is a cornerstone of ERAS, significantly reducing the risk of Venous Thromboembolism (VTE) post-surgery.

Early Mobilization: Barriers - Hurdles & Helps

• Hurdles (Barriers):
  • Patient-Related:
    • Pain (uncontrolled)
    • PONV
    • Fatigue/Weakness
    • Anxiety/Fear
    • Catheters/Drains
    • Poor pre-op mobility
  • Staff-Related:
    • Lack of training/awareness
    • Fear of adverse events (falls)
    • Traditional bedrest culture
    • Staffing shortages
  • System-Related:
    • No standardized protocols
    • Inadequate equipment
    • Poor team communication
• Helps (Solutions):
  • Patient-Focused:
    • Multimodal analgesia
    • PONV prophylaxis
    • Education & counselling
    • Prehabilitation
    • Early line/drain removal
  • Staff Empowerment:
    • Training & education
    • Mobilization champions
    • Clear protocols
    • Teamwork & communication
  • System Support:
    • ERAS pathway integration
    • Sufficient mobility aids
    • Audit & feedback

⭐ Early mobilization within 24 hours post-surgery is a cornerstone of ERAS, proven to reduce length of hospital stay and decrease VTE risk.

Early Mobilization: Protocol - Blueprint for Action

• Core Principle: Structured, progressive activity tailored to patient tolerance.
• Phased Implementation:
  • POD 0: Sit out of bed (SOOB) 1-2 hours post-op; dangle legs.
  • POD 1: Ambulate in room/hallway 2-3 times/day (aim: >10m).
  • POD 2+: Gradually ↑ ambulation distance & frequency (e.g., >30m, 3-4 times/day).
• Safety Checks (STOP & Reassess if):
  • Hemodynamic instability: SBP < 90 or > 180 mmHg; HR < 50 or > 120 bpm.
  • Respiratory distress: SpO₂ < 90%.
  • Severe pain (VAS > 7/10), dizziness, new neurological deficit.
• Team Effort: Nurses, Physiotherapists, Surgeons.
• Patient Engagement: Crucial for adherence; clear instructions.

⭐ Early mobilization (within 24 hours post-surgery) significantly reduces risk of VTE, pneumonia, and length of hospital stay.

High‑Yield Points - ⚡ Biggest Takeaways

• Early mobilization, a core ERAS element, aims for ambulation within 24 hours post-op.
• Reduces key complications: atelectasis, Venous Thromboembolism (VTE), ileus, and infection.
• Preserves muscle mass, improves insulin sensitivity, and accelerates gut function recovery.
• Shortens hospital stay and improves patient-reported outcomes (PROs).
• Effective multimodal analgesia is vital to enable comfortable and early movement.
• A multidisciplinary team approach helps overcome barriers like pain, fatigue, and attached lines/drains.
• Decreases overall morbidity and significantly enhances functional recovery post-surgery.