Current status and influencing factors of early mobilization of patients undergoing laparoscopic radical resection of colorectal cancer

doi:10.3969/j.issn.1674-8115.2023.09.015

Abstract

Abstract:

Objective ·To investigate the status of early mobilization and influencing factors of the patients undergoing laparoscopic radical resection of colorectal cancer (CRC). Methods ·The convenience sampling method was used to select patients undergoing laparoscopic radical resection of CRC in the Department of Colorectal Surgery and Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from January to December, 2022. The patients′ general information, disease-, surgery- and postoperation-related information, and the situation of postoperative early mobilization were collected by bedside interview and electronic medical record system at 24 h, 48 h and 72 h after surgery. The influencing factors were analyzed by univariate analyses and binary Logistic regression. Results ·A total of 277 patients were included. Within 24 h after surgery, 47 patients got out of bed with the early mobilization rate of 16.97%. The walking distance of these patients was 55.46 (18.28, 145.60) m within 24 h after surgery, with a minimum of 2.60 m and a maximum of 803.68 m. The average scores of Brown rating of mobility within 24 h, >24－48 h, and >48－72 h after surgery were 2 (0, 4) points, 8 (0, 10) points, and 8 (8, 10) points, which respectively belonged to the low level, moderate level, and moderate level. There were statistical differences in age, preoperative hemoglobin level, anesthesia duration, and the number of indwelling catheters between the early mobilization group and the non-early mobilization group (all P<0.05). Initial exhaust time, initial defecation time and postoperative length of stay of the early mobilization group were significantly shorter than those of the non-early mobilization group (all P<0.05). There were no postoperative complications in the early mobilization group, while the postoperative complications occurred in 11 patients in the non-early mobilization group with the incidence of complications of 4.78%. Binary Logistic regression analysis showed that age≥70 years old, low preoperative hemoglobin level and long anesthesia duration had significant influence on postoperative early mobilization (all P<0.05). Conclusion ·Early mobilization of patients after laparoscopic radical resection of CRC can significantly accelerate postoperative rehabilitation, but the current status of early mobilization needs to be improved. Age, preoperative hemoglobin level and anesthesia duration are influencing factors of early mobilization.

Key words: early mobilization, colorectal cancer (CRC), laparoscopic surgery, enhanced recovery after surgery (ERAS), influencing factor

CLC Number:

R473.6

LUO Chen, SHEN Ling, WANG Chuanwei, GU Jiani, WANG Jin, ZHAO Li, HUANG Shuai. Current status and influencing factors of early mobilization of patients undergoing laparoscopic radical resection of colorectal cancer[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1201-1210.

Figures/Tables 5

TrendMD

References 41

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Item	Within 24 h after surgery	Within >24‒48 h after surgery	Within >48‒72 h after surgery
Mobility/n(%)	47 (16.97)	167 (60.29)	216 (77.98)
Walking distance/m	55.46 (18.28, 145.60)	138.48 (37.20, 307.88)	169.62 (61.81, 395.57)
Minimum walking distance/m	2.60	2.24	1.12
Maximum walking distance/m	803.68	2 040.92	5 302.80
Brown rating of mobility/point	2 (0, 4)	8 (0, 10)	8 (8, 10)
Brown level of mobility	Low	Moderate	Moderate

Item	Within 24 h after surgery	Within >24‒48 h after surgery	Within >48‒72 h after surgery
Mobility/n(%)	47 (16.97)	167 (60.29)	216 (77.98)
Walking distance/m	55.46 (18.28, 145.60)	138.48 (37.20, 307.88)	169.62 (61.81, 395.57)
Minimum walking distance/m	2.60	2.24	1.12
Maximum walking distance/m	803.68	2 040.92	5 302.80
Brown rating of mobility/point	2 (0, 4)	8 (0, 10)	8 (8, 10)
Brown level of mobility	Low	Moderate	Moderate

Item	Non-early mobilization group (n=230)	Early mobilization group (n=47)	χ²/t value	P value
Gender/n(%)			2.015	0.156
Male	136 (59.13)	33 (70.21)
Female	94 (40.87)	14 (29.79)
Age/n(%)			6.000	0.049
<60 years old	63 (27.39)	21 (44.68)
60‒69 years old	96 (41.74)	17 (36.17)
≥70 years old	71 (30.87)	9 (19.15)
Education level/n(%)			0.778	0.378
Junior high school and below	119 (51.74)	21 (44.68)
Senior high school and above	111 (48.26)	26 (55.32)
Medical insurance payment method/n(%)			1.595	0.451
Urban medical insurance	185 (80.43)	34 (72.34)
Rural medical insurance	37 (16.09)	11 (23.40)
Self-payment	8 (3.48)	2 (4.26)
Marital status/n(%)			2.120	0.548
Married	220 (95.65)	47 (100.00)
Unmarried	6 (2.61)	0 (0)
Divorced	2 (0.87)	0 (0)
Widowed	2 (0.87)	0 (0)
Place of abode/n(%)			0.398	0.528
Town	190 (82.61)	37 (78.72)
Village	40 (17.39)	10 (21.28)
Underlying disease/n(%)			0.049	0.825
No	89 (38.70)	19 (40.43)
Yes	141 (61.30)	28 (59.57)
Preoperative NRS 2002 score/n (%)			0.662	0.416
<3 points	209 (90.87)	45 (95.74)
≥3 points	21 (9.13)	2 (4.26)
Preoperative BMI/n(%)			0.602	0.740
<18.5 kg·m^-2	17 (7.39)	2 (4.26)
18.5‒24.0 kg·m^-2	132 (57.39)	28 (59.57)
>24.0 kg·m^-2	81 (35.22)	17 (36.17)
Preoperative Hb level/n(%)			4.594	0.032
Low	81 (35.22)	9 (19.15)
Normal	149 (64.78)	38 (80.85)
Preoperative albumin level/n(%)			0.854	0.355
Low	130 (56.52)	30 (63.83)
Normal	100 (43.48)	17 (36.17)
Preoperative platelet level/(×10⁹ L^-1)	217.61±76.89	215.47±60.11	0.180	0.857
Cardiac function/n(%)			0.116	0.943
Ⅰ	13 (5.65)	3 (6.38)
Ⅱ	189 (82.17)	39 (82.98)
Ⅲ	28 (12.17)	5 (10.64)
ASA/n(%)			0.620	0.734
Ⅰ	3 (1.30)	0 (0)
Ⅱ	87 (37.83)	18 (38.30)
Ⅲ	140 (60.87)	29 (61.70)
Anesthesia duration/h	3.73±0.95	3.36±0.92	2.601	0.010
Number of indwelling catheters/n	3.04±0.80	2.75±0.87	2.236	0.026
Stopping ECG monitor within 24 h after surgery/n(%)			1.557	0.212
No	20 (8.70)	1 (2.13)
Yes	210 (91.30)	46 (97.87)
Stopping venous PCA within 24 h after surgery/n(%)			2.404	0.121
No	189 (82.17)	34 (72.34)
Yes	41 (17.83)	13 (27.66)
Nausea and vomiting within 24 h after surgery/n(%)			1.123	0.289
No	169 (73.48)	38 (80.85)
Yes	61 (26.52)	9 (19.15)
VAS within 24 h after surgery/point	0.95±1.65	0.75±1.53	0.781	0.436

Item	Non-early mobilization group (n=230)	Early mobilization group (n=47)	χ²/t value	P value
Gender/n(%)			2.015	0.156
Male	136 (59.13)	33 (70.21)
Female	94 (40.87)	14 (29.79)
Age/n(%)			6.000	0.049
<60 years old	63 (27.39)	21 (44.68)
60‒69 years old	96 (41.74)	17 (36.17)
≥70 years old	71 (30.87)	9 (19.15)
Education level/n(%)			0.778	0.378
Junior high school and below	119 (51.74)	21 (44.68)
Senior high school and above	111 (48.26)	26 (55.32)
Medical insurance payment method/n(%)			1.595	0.451
Urban medical insurance	185 (80.43)	34 (72.34)
Rural medical insurance	37 (16.09)	11 (23.40)
Self-payment	8 (3.48)	2 (4.26)
Marital status/n(%)			2.120	0.548
Married	220 (95.65)	47 (100.00)
Unmarried	6 (2.61)	0 (0)
Divorced	2 (0.87)	0 (0)
Widowed	2 (0.87)	0 (0)
Place of abode/n(%)			0.398	0.528
Town	190 (82.61)	37 (78.72)
Village	40 (17.39)	10 (21.28)
Underlying disease/n(%)			0.049	0.825
No	89 (38.70)	19 (40.43)
Yes	141 (61.30)	28 (59.57)
Preoperative NRS 2002 score/n (%)			0.662	0.416
<3 points	209 (90.87)	45 (95.74)
≥3 points	21 (9.13)	2 (4.26)
Preoperative BMI/n(%)			0.602	0.740
<18.5 kg·m^-2	17 (7.39)	2 (4.26)
18.5‒24.0 kg·m^-2	132 (57.39)	28 (59.57)
>24.0 kg·m^-2	81 (35.22)	17 (36.17)
Preoperative Hb level/n(%)			4.594	0.032
Low	81 (35.22)	9 (19.15)
Normal	149 (64.78)	38 (80.85)
Preoperative albumin level/n(%)			0.854	0.355
Low	130 (56.52)	30 (63.83)
Normal	100 (43.48)	17 (36.17)
Preoperative platelet level/(×10⁹ L^-1)	217.61±76.89	215.47±60.11	0.180	0.857
Cardiac function/n(%)			0.116	0.943
Ⅰ	13 (5.65)	3 (6.38)
Ⅱ	189 (82.17)	39 (82.98)
Ⅲ	28 (12.17)	5 (10.64)
ASA/n(%)			0.620	0.734
Ⅰ	3 (1.30)	0 (0)
Ⅱ	87 (37.83)	18 (38.30)
Ⅲ	140 (60.87)	29 (61.70)
Anesthesia duration/h	3.73±0.95	3.36±0.92	2.601	0.010
Number of indwelling catheters/n	3.04±0.80	2.75±0.87	2.236	0.026
Stopping ECG monitor within 24 h after surgery/n(%)			1.557	0.212
No	20 (8.70)	1 (2.13)
Yes	210 (91.30)	46 (97.87)
Stopping venous PCA within 24 h after surgery/n(%)			2.404	0.121
No	189 (82.17)	34 (72.34)
Yes	41 (17.83)	13 (27.66)
Nausea and vomiting within 24 h after surgery/n(%)			1.123	0.289
No	169 (73.48)	38 (80.85)
Yes	61 (26.52)	9 (19.15)
VAS within 24 h after surgery/point	0.95±1.65	0.75±1.53	0.781	0.436

Postoperative recovery indicator	Non-early mobilization group (n=230)	Early mobilization group (n=47)	χ² value	P value
Initial exhaust time/n(%)			4.752	0.029
<24 h	49 (21.30)	17 (36.17)
≥24 h	181 (78.70)	30 (63.83)
Initial defecation time/n(%)			3.809	0.049
<72 h	106 (46.09)	29 (61.70)
≥72 h	124 (53.91)	18 (38.30)
Postoperative length of stay/n(%)			5.650	0.017
≤7 d	15 (6.52)	8 (17.02)
>7 d	215 (93.48)	39 (82.98)