Effect of Early Mobilization on Gastrointestinal Functions After Abdominal Surgery: Systematic Review

Year 2021, Volume: 30 Issue: 3, 166 - 176, 30.09.2021

İnci Kırtıl , Nevin Kanan

Abstract

The aim of this systematic review was to examine the current literature to determine the effects of early mobilization interventions on gastrointestinal functions after abdominal surgery. This systematic review was created by searching Pubmed, Google Scholar, ScienceDirect, Cochrane, TürkMedline ve Ulakbim databases with keywords related to “early mobilization”, “abdominal surgery” and “gastrointestinal functions”. Articles published between 2010-2020, with in English and Turkish, prospective randomized controlled and quasi-experimental design, and open to full text access were included. As a result of the literature review, 7 articles meeting the inclusion criteria were examined within the scope of the study. It was determined that 6 of the studies were prospective randomized controlled and 1 was quasi-experimental research design. It was found that the mobilization programs applied in the studies and the outcome variables examined differed. In most of the studies, it was determined that early and planned mobilization which applied postoperatively shorten the time of first flatus, stool and time to start the first oral intake, and decreased the experienced abdominal distention, nausea and vomiting. The reviewed literature showed that postoperative early and planned mobilization programs had positive effects on the first flatus and stool time, the severity of abdominal distention, the incidence of nausea and vomiting, and time to start oral intake, but further studies are needed on some components.

Keywords

Abdominal surgery, early mobilization, gastrointestinal functions

Abdominal Cerrahi Girişim Sonrası Erken Mobilizasyonun Gastrointestinal İşlevlere Etkisi: Sistematik Derleme

Abstract

Çalışmanın amacı, abdominal cerrahi girişimlerden sonra uygulanan erken mobilizasyon girişimlerinin gastrointestinal işlevlere etkisini belirlemeye yönelik mevcut literatürün incelenmesidir. Bu sistematik derleme, Pubmed, Google Scholar, ScienceDirect, Cochrane, TürkMedline ve Ulakbim veri tabanlarında "erken mobilizasyon", "abdominal cerrahi" ve "gastrointestinal işlevler" ile ilgili anahtar kelimelerle arama yapılarak oluşturuldu. Sistematik derlemeye 2010-2020 yılları arasında yayınlanan, yayın dili İngilizce ve Türkçe olan, randomize kontrollü deneysel ve yarı-deneysel tasarım tipinde olan ve tam metin erişimine açık makaleler dahil edildi. Literatür taraması sonucunda, dahil edilme kriterlerini karşılayan 7 makale çalışma kapsamında incelendi. İncelenen çalışmaların 6’sının prospektif randomize kontrollü deneysel ve 1’inin yarı-deneysel araştırma tasarım tipinde olduğu belirlendi. Çalışmalarda uygulanan mobilizasyon programlarının ve incelenen sonuç değişkenlerinin farklılık gösterdiği saptandı. Çalışmaların çoğunda, ameliyat sonrası uygulanan erken ve planlı mobilizasyonun, ilk gaz ve gaita çıkış zamanı ile ilk oral alıma başlama sürelerini kısalttığı, deneyimlenen abdominal distansiyon ve bulantı-kusma şiddetlerini azalttığı belirlendi. İncelenen literatür, ameliyat sonrası uygulanan erken ve planlı mobilizasyon programlarının, ilk gaz/gaita çıkış süresi, abdominal distansiyon şiddeti, bulantı-kusma görülme durumu ve oral alıma başlama zamanı üzerinde olumlu etkilerinin olduğunu, ancak bazı ögeler üzerinde daha fazla çalışmaya gereksinim olduğunu gösterdi.

Keywords

abdominal cerrahi, erken mobilizasyon, gastrointestinal işlevler

References

• 1. Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A. Global burden of postoperative death. Lancet. 2019;393:401.
• 2. Boden I, Robertson KI, Neil A, Reeve J, Palmer JA, Skinner HE et al. Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial. J Physiother. 2020;66(2020):180-7.
• 3. İzveren ÖA, Dal Ü. Abdominal cerrahi girişim uygulanan hastalarda görülen erken dönem sorunları ve bu sorunlara yönelik hemşirelik uygulamaları. Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Hemşirelik Dergisi. 2011;18(2):36-46.
• 4. Taşdemir N, Şenol Çelik S. Hastaların cerrahi girişim sonrası abdominal distansiyona yönelik deneyimleri. Ege Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2010;26(3):23-31.
• 5. Wakeling HG, McFall MR, Jenkins CS, Woods WGA, Miles WFA, Barclay GR et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95(5):634-42.
• 6. Sun D, Li W, Li S, Cen Y, Xu Q, Li Y et al. Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial. Nutrition Journal. 2017;16(11):1-10.
• 7. Büyükyılmaz F, Şendir M. Cerrahi hastalarında barsak boşaltımı sorunlarına yönelik hemşirelik bakımı. Maltepe Üniversitesi Hemşirelik Bilim ve Sanat Dergisi. 2009;2(1):74-81.
• 8. Wallström A, Frisman GH. Facilitating early recovery of bowel motility after colorectal surgery: a systematic review. J Clin Nurs. 2013;23:24-44.
• 9. Saxena A, Mahendru V. Factors affecting bowel motility following abdominal surgery: a clinical study. Saudi Surg J. 2015;3(1):1-6.
• 10. Gustafsson UO, Scott MJ, Hübner M, Nygren J, Demartines M, Francis N et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World J Surg. 2019;43:659-95.
• 11. Acar C, Toktaş C. Laparoskopik cerrahinin temel fizyolojik etkileri. Türk Üroloji Seminerleri. 2010;1:119-25.
• 12. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742-53.
• 13. Kouba EJ, Wallen ME, Pruthi RS. Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Urology. 2007;70(6):1053-6.
• 14. Kalisch JB, Lee S, Dabney WB. Outcomes of inpatient mobilization: a literature review. J Clin Nurs. 2013;23(11-12):1-16.
• 15. Teodoro CR, Breault K, Garvey C, Klick C, O’Brien J, Purdue T et al. STEP-UP: Study of the effectiveness of a patient ambulation protocol. Medical Surgical Nursing. 2016;25(2):111-6.
• 16. Burgess LC, Wainwright WT. What is the evidence for early mobilisation in elective spine surgery? a narrative review. Healthc. 2019;7(92):1-21.
• 17. Grass F, Pache B, Martin D, Addor V, Hahnloser D, Demartines N et al. Feasibility of early postoperative mobilisation after colorectal surgery: a retrospective cohort study. Int J Surg. 2018;56(2018):161-6.
• 18. National Institute for Health and Care Excellence (NICE)-Stroke and transient ischaemic attack in over 16s: diagnosis and initial management-evidence review for very early mobilisation. Available from: https://www.nice.org.uk/guidance/ng128/resources/stroke-and-transient-ischaemic-attack-in-over-16s-diagnosis-and-initial-management-pdf-66141665603269 Accessed: 12 December 2020
• 19. Wiklund M, Sundqvist E, Olsen MF. Physical activity in the immediate postoperative phase in patients undergoing Roux-en-Y gastric bypass-a randomized controlled trial. Obes Surg. 2015;25:2245-50.
• 20. Kaneda H, Saito Y, Okamoto M, Maniwa T, Minami K, Imamura H. Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients. Gen Thorac Cardiovasc Surg. 2007;55:493-8.
• 21. Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum. 2011;54(1):21-8.
• 22. Sindell S, Wayne Causey M, Bradley T, Poss M, Moonka R, Thirlby R. Expediting return of bowel function after colorectal surgery. Am J Surg. 2012;203(5):644-8.
• 23. Dube JV, Kshirsagar NS. Effect of planned early recommended ambulation technique on selected post caesarean biophysiological health parameters. J Krishna Inst Medical Sci Univ. 2014;3(1):41-8.
• 24. Jensen BT, Jensen JB, Laustsen S, Petersen AK, Sondergaard I, Borre M. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial. J Multidiscip Healthc. 2014;7:301-11.
• 25. Kaur H, Kaur S, Sikka P. The effectiveness of early ambulation in postoperative recovery among post-cesarean mothers admitted in selected areas of Nehru Hospital, PGIMER, Chandigard, 2015. Nursing and Midwifery Research Journal. Available from: https://nrfninechd.com/a-quasi-experimental-study-to-assess-the-effectiveness-of-early-ambulation-in-post-operative-recovery-among-post-caesarean-mothers-admitted-in-selected-areas-of-nehru-hospitalpgimerchandigarh/ Accessed: 5 December 2020
• 26. Terzioğlu F, Şimşek S, Karaca K, Sariince N, Altunsoy P, Salman MC. Multimodal interventions (chewing gum, early oral hydration, and early mobilisation) on the intestinal motility following abdominal gynaecologic surgery. J Clin Nurs. 2013;22:1917-25.
• 27. Şahin E, Terzioğlu F. The effect of gum chewing, early oral hydration, and early mobilization on intestinal motility after cesarean birth. Worldviews Evid Based Nurs. 2015;12(6):380-8.
• 28. Ni C, Wang Z, Huang Z, Zhou H, Fu L, Cai H et al. Early enforced mobilization after liver resection: a prospective randomized controlled trial. Int J Surg. 2018;54(2018):254-8.
• 29. Hassan EH, El-Sadek ANE, Ali LAH. Effect of three different nursing interventions on intestinal motility and women’s satisfaction post-cesarean section birth. Am J Nurs Res. 2019;7(6):932-41.
• 30. Hu Y, McArthur A, Yu Z. Early postoperative mobilization in patients undergoing abdominal surgery: a best practice implementation project. JBI Database System Rev Implement Rep. 2019;17:1-21.
• 31. Barai D, Vahitha S. Effectiveness of early ambulation on post-operative recovery among primiparous post cesarean mothers-a randomized control trial. Int J Sci Res. 2019;8(9):3-6.
• 32. Abd-Elhamed AG, Osman MA, Mobarak AA, Hussien AA. Efficacy of early mobilization on bowel motility for children after abdominal surgery. Assiut Sci Nurs J. 2019;7(19):78-89.
• 33. Currier D, TeKolste D, Wheatley MA. Why day zero matters in early ambulation for postoperative patients: an evidence-based project. Virginia Henderson Global Nursing e-Repository, 2018. Available from: https://sigma.nursingrepository.org/handle/10755/624140 Accessed: 8 December 2020
• 34. Doherty-King B, Yoon JY, Pecanac K, Brown R, Mahoney J. Frequency and duration of nursing care related to older patient mobility. J Nurs Scholarsh. 2013;46(1):20-7.
• 35. Center for Reviews and Dissemination, Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care. York: York Publishing Services, 2009. Available from: https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf Accessed: 6 December 2020
• 36. Wahyuni S, Wahyuni AS, Tarigan R, Syarifah S. Effect of early ambulation to peristaltic activity of abdominal post-operative patients in Medan city hospital, Indonesia. J Phys. 2019;1317:1-5.
• 37. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg. 2013;17(5):962-72.
• 38. Chapman SJ, Thorpe G, Vallance AE, Harji DP, Lee MJ, Fearnhead NS et al. Systematic review of definitions and outcome measures for return of bowel function after gastrointestinal surgery. Br J Nurs. 2018;3(1):1-10.
• 39. Kibler AV, Hayes RM, Johnson DE, Anderson LW, Just SL, Wells NL. Early postoperative ambulation: back to basics. Am J Nurs. 2012;112(4):63-9.
• 40. Rajamani S, Sıthık SA, Shanthi C. Effectiveness of early ambulation on postoperative recovery among the women who has undergone abdominal hysterectomy at government Rajaji hospital (Yükseklisans tezi). Chennai, Madurai Medical Collage, 2018. Available from: http://repository-tnmgrmu.ac.in/11650/1/300327518meenakshi.pdf Accessed: 9 December 2020
• 41. Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery. Anesth Analg. 2018;126(6):1896-1907.
• 42. Talakoub R, Golparvar M, Arshi R. The effect of early ambulation on the incidence of neurological complication after spinal anesthesia with lidocaine. J Res Med Sci. 2015;20(4):383-6.
• 43. Asada J, Ida M, Sato M, Okamoto N, Kawaguchi M. Associated factors with delayed ambulation after abdominal surgery. J Anesth. 2019;33:680-4.