Mobilization immediately after elective abdominal surgery : respiratory effects and patients' and healthcare professionals' experiences

To prevent postoperative complications after abdominal surgery, mobilization is highly recommended and suggested to start as soon as possible. However, few studies have investigated the respiratory effects of immediate postoperative mobilization among patients undergoing elective open or robot-assisted laparoscopic abdominal surgery. Nor have patients´ and healthcare professionals´ experiences of such an early mobilization procedure been investigated.

Participants in study I to III were recruited from an out-patient pre-anesthesia clinic at Karolinska University Hospital Solna, Stockholm. For paper IV, the participants were recruited from the postoperative recovery unit at the same hospital.

Paper I was a 3-armed RCT, consecutively including 214 patients who underwent elective open or robot-assistedlaparoscopic gynecological, urological, or endocrinological abdominal surgery with ananesthetic duration of >2 hours. Patients were randomized to mobilization only (to sit in a chair) (n = 76), mobilization (to sit in a chair) in combination with breathing exercises (n = 73), or to be controls (no treatment) (n = 65). The interventions started within 2 hours after arrival at the postoperative recovery unit. The results showed that compared with the controls, SpO2 and PaO2 improved for patients in the intervention groups.

Paper II was a secondary analysis of data from the RCT including the patients who were assigned to and complied with the mobilization interventions (n = 137). Mobilization initiation time and duration of mobilization were investigated in relation to SpO2 and PaO2. The results indicated that mobilization within the first hour after surgery was not superior to being mobilized within the second hour regarding SpO2 and PaO2. Further, SpO2 and PaO2 were similar between the groups irrespective of whether the patients were mobilized for less than 30 minutes, between 30 and 90 minutes, or longer than 90 minutes.

Paper III included face-to-face interviews with 23 patients who were randomized to one of the mobilization interventions. The overarching theme that emerged from the content analysis was “To do whatever it takes to get home earlier”, which was built on the three categories; “The impact of mobilization”, “To feel safe and be confident with the mobilization process”, and “Experiences and motivational factors”.

Paper IV, was an interview study of 17 healthcare professionals who had been involved in mobilization of patients in the RCT. The interviews were analyzed with content analysis and resulted in the overarching theme “A changed mindset” which represented a turning point when the healthcare professionals observed that mobilization was safe and beneficial for the patients, and their safety concerns were reduced.

The overall conclusion of this thesis was that mobilization immediately after abdominal surgery improved SpO2 and PaO2. Initiation time and duration of mobilization seemed to be of less importance. Patients found that it improved their physical and mental well-being. The healthcare professionals ‘experienced the postoperative recovery unit was a safe place for initiating mobilization as long as they had access to sufficient resources and a wellfunctioning multiprofessional team of nurses, assistant nurses and physiotherapists.

List of scientific papers

I. Svensson-Raskh A, Schandl A, Ståhle A, Nygren-Bonnier M, Fagevik Olsén M. Mobilization started within 2 hours after abdominal surgery improves peripheral and arterial oxygenation: A single-center randomized controlled trial. Physical Therapy. 2021; 101:1-11.
https://doi.org/10.1093/ptj/pzab094

II. Svensson-Raskh A, Fagevik Olsén M, Hagströmer M, Schandl A, Nygren-Bonnier M. Time point being mobilized, duration of mobilization and respiratory function after abdominal surgery. [Manuscript]

III. Svensson-Raskh A, Schandl A, Holdar U, Fagevik Olsén M, Nygren-Bonnier M. ”I have everything to win and nothing to lose”: Patient experiences of mobilization out of bed immediately after abdominal surgery. Physical Therapy. 2020; 100(12):2079-2089.
https://doi.org/10.1093/ptj/pzaa168

IV. Svensson-Raskh A, Fagevik Olsén M, Nygren-Bonnier M, Schandl, A. Healthcare professionals´ experiences of mobilization within 2 hours after abdominal surgery: a qualitative study. [Submitted]