Ambulation of Hospitalized Gynecologic Surgical Patients

Abstract

Several randomized studies have suggested that patients benefit from early ambulation after abdominal surgery. Research on possible benefits has been hampered by the lack of a quantifiable, standardized definition for adequate ambulation or any guidelines to determine the adequacy of postsurgical ambulation. Moreover, no data are available from randomized trials or other studies that quantify how much the average patient ambulates after abdominal surgery. This randomized controlled trial was designed to determine whether specific ambulation goals (goal-enhanced postoperative care) affect patient-perceived barriers to ambulation or the adequacy of in-hospital postoperative ambulation of patients who underwent major gynecology surgery. One hundred forty-six women undergoing major gynecologic surgery at an urban medical center were randomized to usual care (n = 77) or goal-enhanced postoperative care (n = 69). The primary study outcomes were the number of pedometer-recorded steps documented in the 24 hours immediately before discharge and patient-perceived barriers to ambulation. Patient-identified ambulation obstacles were assessed using a 10-question patient survey. A Mann-Whitney U test was used for group comparison. Of the 129 patients with outcome data, 8 (12%) in each group took no pedometer-recorded steps before discharge. There was no significant group difference between the median numbers of steps in the ambulation goal group and usual care group (80 vs 87 steps, respectively; P = 0.7). From a patient perspective, the most common barriers to ambulation were indwelling catheters (38.5%), intravenous poles (28%), and pain (12.5%); all 3 are modifiable. A clinically and statistically significant increase in the median number of steps taken was found for patients who underwent minimally invasive surgery (n = 143) compared with those who had a laparotomy (n = 27); P = 0.035. These data show that easily modifiable barriers to ambulation identified by patients can be quantified and have the potential to increase postoperative ambulation, improving postoperative recovery. Despite encouragement to ambulate, 12% of gynecologic surgical patients did not walk while hospitalized.