A feasibility study into the use of the tilt table in the early postoperative rehabilitation of patients undergoing sacrectomy surgery with plastic reconstruction within the Orthopaedic Oncology Service

Abstract

Purpose Standard post-operative care following sacrectomy requiring plastic surgical reconstruction limits hip flexion and avoids wound pressure. Extended bed rest adversely affects patient function, strength and range of movement. This feasibility study assessed whether early postoperative use of the tilt table was possible and promoted faster mobilisation. Methods Data from 10 patients were collected; five from a “standard tilt table group” and five from an “early tilt table group”. Number of days post-operatively patients stood, walked, and were discharged was recorded. Results Patients had undergone partial or sub-total sacrectomy with wound closure using a variety of plastic surgical techniques. The “early tilt table” group started on the tilt table at 4.8 ± 2.8 days whereas the “standard tilt table” group started at 13 ± 5.1 days (p = 0.01*). Patients in the “early tilt table group” walked significantly earlier [10.6 ± 2.7*] than the standard group (28 ± 13) (p = 0.02*). LOS in the “early” group was 37.11 ± 11.9 days compared to 58.2 ± 21.8 days in the standard group (p = 0.10). No difference in complications between the groups. Conclusions Early tilt table use after sacrectomy was safe and enabled a faster achievement of functional goals, thereby reducing LOS. This highlights the need for further evaluation of rehabilitation practice for this group of patients. IMPLICATIONS FOR REHABILITATION Multidisciplinary discussion between the plastic surgeon, the tissue viability nurse and the physiotherapist about post-operative precautions and their impact on rehabilitation is essential and may enable earlier use of the tilt table. Early use of the tilt table can enable quicker mobilisation leading to the faster achievement of functional milestones and potentially a reduced length of stay (LOS) without detriment to patient outcomes/complications. The early use of the tilt table can support the central goal of surgery of enabling independence, especially as with such extensive surgery there is a big risk of institutionalisation and prolonged disability. There are potential mental health benefits to earlier mobilisation; however, this needs further investigation.