Early Ambulation and Rehabilitation

Early Ambulation & Rehab - Why Walk Wins

• Core Principle: Mobilize patients ASAP post-surgery.
• Key Benefits:
  • Prevents DVT/PE (↓ stasis) & respiratory complications (atelectasis, pneumonia).
  • Reduces muscle wasting, pressure sores, and paralytic ileus.
  • Improves circulation, gut motility, and patient well-being.
  • Shortens hospital stay and ↓ healthcare costs.
• When to Start: Ideally within 24 hours if hemodynamically stable.
• Process:

• 📌 Mnemonic: "WALK" - Wins Against Lots of Komplications.

⭐ Early ambulation (within 24 hours) is a cornerstone of ERAS (Enhanced Recovery After Surgery) protocols, significantly reducing VTE risk.

Early Ambulation & Rehab - Setting the Stage

• Preoperative Assessment & Optimization:
  • Baseline functional status (mobility, frailty).
  • Identify & manage comorbidities (cardiac, respiratory, DM).
  • VTE risk assessment (e.g., Caprini score); optimize nutrition.
• Patient & Family Education:
  • Benefits: ↓VTE, ↓atelectasis, ↓LOS (Length Of Stay), improved pain control.
  • Mobilization plan, pain expectations, deep breathing & coughing exercises.
• Multimodal Pain Management Plan:
  • Opioid-sparing: Paracetamol, NSAIDs, gabapentinoids.
  • Regional anesthesia (epidural, nerve blocks) where appropriate.
• DVT Prophylaxis Strategy:
  • Mechanical: Intermittent Pneumatic Compression (IPC), Graduated Compression Stockings (GCS).
  • Pharmacological: LMWH/UFH based on risk.
• ERAS (Enhanced Recovery After Surgery) Principles:
  • No prolonged fasting, carbohydrate loading.
  • Prefer MIS (Minimally Invasive Surgery).
  • Goal-directed fluid therapy; early removal of catheters/drains.

⭐ Preoperative education focusing on the benefits and techniques of early mobilization, alongside effective pain management strategies, is crucial for patient adherence and successful postoperative recovery within ERAS pathways.

Early Ambulation & Rehab - First Steps Forward

• Goal: Speed recovery; prevent VTE, atelectasis, ileus, muscle atrophy.
• Initiation: POD 0-1, if stable.
  • In-bed: Active ROM, ankle pumps.
  • Sit ("dangling"); check orthostasis (SBP drop >20 / DBP >10 mmHg).
• Progression:
  • Stand, transfer, begin weight-bearing.
  • Ambulate with aid (walker/PT); short, frequent walks (3-4x/day).
  • Gradually ↑ distance, frequency, independence.
  • Stairs when stable.
• Essentials:
  • Pain control (VAS <4).
  • Patient education.
  • Physiotherapy.
  • 📌 MEMO: Move Early, Move Often.
• Monitor:
  • Vitals, pain.
  • ⚠️ Dizziness, syncope, fatigue, dyspnea, chest pain, wound issues.

⭐ Early ambulation, typically within 24 hours post-surgery, is a cornerstone of Enhanced Recovery After Surgery (ERAS) protocols, significantly reducing risks of DVT/PE, pneumonia, and overall length of hospital stay.

Early Ambulation & Rehab - Beyond the Walk

• Early Ambulation: Mobilize ASAP (typically within 24 hours post-op).
  • Benefits: ↓DVT/PE, ↓atelectasis/pneumonia, ↓ileus, ↓muscle atrophy, ↓pressure sores. ↑circulation, ↑healing, ↑mood.
  • Contraindications: Hemodynamic instability, active bleeding, uncontrolled pain, specific surgical restrictions.
• Comprehensive Rehabilitation (Beyond Walking):
  • Multimodal: Physiotherapy (PT), Occupational Therapy (OT), Respiratory Therapy (RT), nutrition, psych support.
  • PT: ROM, strength, gait, balance.
  • RT: Deep breathing, incentive spirometry, coughing.
  • OT: Activities of Daily Living (ADL) retraining.
  • Goals: ↑Function, ↑independence, ↑QoL.
  • ERAS protocols: key for early mobilization.

  ⭐ ERAS cornerstone: ↓LOS (Length Of Stay), ↓VTE & other complications.

High‑Yield Points - ⚡ Biggest Takeaways

• Early ambulation significantly reduces risk of DVT/PE, atelectasis, and postoperative pneumonia.
• It improves circulation, maintains muscle strength, and promotes faster wound healing.
• Aids in reducing hospital stay and shortens duration of postoperative ileus.
• Typically initiated within 24 hours post-surgery, tailored to patient tolerance.
• Key contraindications: hemodynamic instability, active hemorrhage, unstable fractures, or unmanaged severe pain.
• Adequate analgesia is essential to facilitate early mobilization and patient compliance.
• Rehabilitation often involves a multidisciplinary team for optimal functional recovery and return to daily activities.