Cerrahi girişimlerden sonra erken ve hedefe yönelik mobilizasyon

Günümüzde hala standart bir tanımı olmayan erken mobilizasyon, tüm cerrahi girişimler sonrasında hızlı iyileşmenin önemli bir bileşenidir. Erken ve hedefli mobilizasyonun sağlanmasıyla, cerrahi girişim sonrası birçok komplikasyon önlenmekte, iyileşme ve hastanede kalış süresi kısalmaktadır. Ancak erken ve hedefli mobilizasyonun sağlanmasının önünde, hem sağlık ekibi üyeleri hem de hastalar tarafından bildirilen birçok engel bulunmaktadır. Aynı zamanda, günümüzde bu konuda klinik uygulamalara rehberlik edecek ölçüde güçlü kanıtlar bulunmamaktadır. Sağlık kurumlarında cerrahi hastalarına özgü mobilizasyon programlarının oluşturulması, hastaların preoperatif dönemde bu konuda bilgilendirilmesi, adım hedeflerinin belirlenmesi, motivasyonlarının sağlanması, adım sayılarının izlenmesi ve mobilizasyon günlüğü tutmaları yönünde cesaretlendirilmesi, erken ve hedefli mobilizasyonun sağlanmasına yönelik atılabilecek adımlardır. Erken mobilizasyonun multidisipliner bir ekip işi olduğunun da altı çizilmektedir. Bir sağlık profesyoneli olarak hemşireler, cerrahi girişim sonrası bakım kalitesini sürdürmek için erken mobilizasyon programlarının uygulanmasında multidisipliner ekibin önemli bir üyesidir. Bu derleme, cerrahi hemşirelerinin ameliyat sonrası erken ve hedefli mobilizasyon uygulamalarındaki rol ve sorumluluklarını, erken ve hedefli mobilizasyonun önemini, erken ve hedefli mobilizasyonun sağlanmasında karşılaşılan engelleri ve güncel rehberlerin bu konudaki önerilerini vurgulamak amacıyla yazılmıştır.

Early and targeted mobilization after surgical interventions

Early mobilization, which still has no standard definition, is an important component of enhanced recovery after all surgical interventions. By providing early and targeted mobilization, many postsurgical complications can be prevented, and the recovery period and hospital stay can be shortened. However, there are many obstacles reported by both healthcare team members and patients in the achievement of early and targeted mobilization. In addition, there is currently no strong evidence to guide clinical practice in this context. The establishment of mobilization programs specific to surgical patients in healthcare institutions, informing patients about the mobilization process in the preoperative period, determining step goals, promoting motivation, monitoring the number of steps, and encouraging patients to keep a mobilization diary are among the practices that can be implemented to ensure early and targeted mobilization. It is also underlined that early mobilization involves multidisciplinary teamwork. As healthcare professionals, nurses are an important member of the multidisciplinary team in the implementation of early and targeted mobilization programs to maintain the quality of care after surgery. This review aimed to highlight the roles and responsibilities of surgical nurses in early and targeted mobilization practices after surgery and the importance of early and targeted mobilization and discuss the barriers encountered in achieving early and targeted mobilization and the recommendations of current guidelines on this subject.

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  • Ries E. Some radical changes in the after-treatment of celiotoiny cases. The Journal of the American Medical Association, 1899:33;454.
  • Castelino T, Fiore JF, Niculiseanu P, Landry T, Augustin B, et al. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery, 2016:159(4);991-1003. DOI: 10.1016/j.surg.2015.11.029
  • Yurko YY, Fearon KCH, Young-Fadok TM. Early nutrition and early mobilization: why they are important and how to make it happen. In: Feldman SL, Delaney CP, Ljungqvist O, Carli F, eds. The SAGES/ERAS Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery (E-book) Switzerland: Springer International Publishing; 2015. p.167-79. DOI: 10.1007/978-3-319-20364-5
  • Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica, 2016:60(3);289-334. DOI: 10.1111/aas.12651
  • Pashikanti L, Ah Von D. Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clinical Nurse Specialist, 2012:26(2);87-94. DOI: 10.1097/NUR.0b013e31824590e6
  • Hussey JM, Yang T, Dowds J, O’Connor L, Reynolds JV, et al. Quantifying postoperative mobilisation following oesophagectomy. Physiotherapy, 2019:105(1);126-133. DOI: 10.1016/j.physio.2018.08.004
  • Kalisch JB, Lee S, Dabney WB. Outcomes of inpatient mobilization: a literature review. Journal of Clinical Nursing, 2013:23(11-12):1486-1501. DOI: 10.1111/jocn.12315
  • Temple-Oberle C, Shea-Budgell AM, Tan M, Semple LJ, Schrag C, Barreto M, et al. Consensus review of optimal perioperative care in breast reconstruction: Enhanced Recovery After Surgery (ERAS) Society recommendations. Plastic and Reconstructive Surgery, 2017:139(5):1056e-1071e. DOI: 10.1097/PRS.0000000000003242
  • 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. Obesity Surgery, 2015:25(12);2245-2250. DOI: 10.1007/s11695-015-1690-y
  • Ziyaeifard M, Khoo BGF, Lotfian S, Azarfarin R, Aminnejad R, Alikhani R, et al. Effects of early mobilization protocol on cognitive outcome after cardiac surgery. Annals of Anesthesiology and Critical Care, 2018:3(1);1-8.
  • Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M, et al. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS) society recommendations. Clinical Nutritions, 2013:32;879-887. DOI: 10.1016/j.clnu.2013.09.014
  • Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Diseases of the Colon and Rectum, 2017:60(8);761-784. DOI: 10.1097/DCR.0000000000000883
  • 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 Journal of Surgery, 2019:43(3);659-695. DOI: 10.1007/s00268-018-4844-y
  • Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS). European Journal of Cardio-Thoracic Surgery, 2019:55(1);91-115. DOI: 10.1093/ejcts/ezy301
  • 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. Retrieved from (20.09.2023): https://sigma.nursingrepository.org/handle/10755/624140
  • 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);111-116.
  • Grass F, Pache B, Martin D, Addor V, Hahnloser D, Demartines N, Hübner M. Feasibility of early postoperative mobilisation after colorectal surgery: a retrospective cohort study. International Journal of Surgery, 2018:56;161-166. DOI: 10.1016/j.ijsu.2018.06.024
  • Au D, Matthew AG, Lopez P, Hilton WJ, Awasthi R, Bousquet-Dion G, et al. Prehabilitation and acute postoperative physical activity in patients undergoing radical prostatectomy: a secondary analysis from an RCT. Sports Medicine-Open, 2019:5(18);1-7. DOI: 10.1186/s40798-019-0191-2
  • Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS) Society recommendations. British Journal of Surgery, 2014:101(10);1209-1229. DOI: 10.1002/bjs.9582
  • Van der Meij E, van der Ploeg HP, van den Heuvel B, Dwars BJ, Meijerink WJHJ, Bonjer HJ, et al. Assessing pre- and postoperative activity levels with an accelerometer: a proof of concept study. BMC Surgery, 2017:17(1);56. DOI: 10.1186/s12893-017-0223-0
  • Burgess LC, Wainwright WT. What is the evidence for early mobilisation in elective spine surgery? A narrative review. Healthcare, 2019:7(92);1-21. DOI: 10.3390/healthcare7030092
  • De Almeida EPM, de Almeida JP, Landoni G, Galas FRBG, Fukushima JT, Fominskiy E, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial. British Journal of Anaesthesia, 2017:119(5);900-907. DOI: 10.1093/bja/aex250
  • Scott MJ, Baldini G, Fearon KCH, Feldheiser A, Feldman LS, Gan TJ, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiologica Scandinavica, 2015:59(10);1212-1231. DOI: 10.1111/aas.12601
  • Dort CJ, Farwell GD, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, et al. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction a consensus review and recommendations from the Enhanced Recovery After Surgery Society. JAMA Otolaryngology-Head and Neck Surgery, 2016:143(3);292-303. DOI: 10.1001/jamaoto.2016.2981
  • Vermişli Peker S, Çakmak Ö, Müezzinoğlu T, Aslan G, Baydur H. Radikal sistektomi ve ileal loop yapılan hastalarda erken mobilizasyonun iyileşme süreci ve yaşam kalitesine etkisi. 3. Uluslararası 11. Ulusal Türk Cerrahi ve Ameliyathane Hemşireliği Kongresi Özet Bildiri Kitabı, 2019, ss: 830-831.
  • Calvo Vecino JM, Hernandez EV, Ramirez Rodriguez JM, Segurola CL, Trapero CM, Quintas CN. Enhanced recovery for abdominal surgery clinical pathway. Spanish Ministry of Health, Social Services and Equality Working Group, 2015. Retrieved from (20.09.2023): http://portal.guiasalud.es/contenidos/iframes/documentos/opbe/2015-07/ViaClinica-RICA_English.pdf
  • Hanada M, Kanetaka K, Hidaka S, Taniguchi K, Oikawa M, Sato S, et al. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video‑assisted thoracoscopic surgery on the esophagus. Esophagus, 2018:15(2);69-74. DOI: 10.1007/s10388-017-0600-x
  • Nygren J, Thacker J, Carli F, Fearon KCH, Norderval S, Lobo DN, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clinical Nutrition, 2013:31(6);801-816. DOI: 10.1016/j.clnu.2012.08.012
  • Moningi S, Patki A, Padhy N, Ramachandran G. Enhanced recovery after surgery: an anesthesiologist's perspective. Journal of Anaesthesiology Clinical Pharmacology, 2019:35(Suppl 1);S5-S13. DOI: 10.4103/joacp.JOACP_238_16
  • Low ED, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy KM, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. World Journal of Surgery, 2019:43;299-330. DOI: 10.1007/s00268-018-4786-4
  • Hashem DM, Nelliot A, Needham MD. Early mobilization and rehabilitation in the ICU: moving back to the future. Respiratory Care, 2016:61(7);971-979. DOI: 10.4187/respcare.04741
  • Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. The Journal of Bone and Joint Surgery, 2007:89-B(3);316-322. DOI: 10.1302/0301-620X.89B3.18196
  • Chandrasekaran S, Ariaretnam SK, Tsung J, Dickison D. Early mobilization after total knee replacement reduces the incidence of deep venous thrombosis. ANZ Journal of Surgery, 2009:79(2009);526-529. DOI: 10.1111/j.1445-2197.2009.04982.x
  • Lassen K, Coolsen EMM, Slim K, Carli F, de Aguilar-Nascimento EJ, Schafer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clinical Nutrition, 2012:31(6);817-830. DOI: 10.1016/j.clnu.2012.08.011
  • Macones AG, Caughey BA, Wood LS, Wrench JI, Huang J, Norman M, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations. American Journal of Obstetrics and Gynecology, 2019:221(3);247.e1-247.e9. DOI: 10.1016/j.ajog.2019.04.012
  • Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio WV. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Diseases of the Colon & Rectum, 2003:46(7);851-859. DOI: 10.1007/s10350-004-6672-4
  • Halpern WL. Early ambulation is crucial for improving patient health. The American Journal of Nursing, 2017:117(6);15. DOI: 10.1097/01.NAJ.0000520240.29643.e2
  • Larsen K, Hansen TB, Thomsen PB, Christiansen T, Soballe K. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. The Journal of Bone and Joint Surgery, 2009:91(4);761-772. DOI: 10.2106/JBJS.G.01472
  • Guerra ML, Singh JP, Taylor FN. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clinical Rehabilitation, 2014:29(9);844-854. DOI: 10.1177/0269215514558641
  • Cook DJ, Thompson EJ, Prinsen SK, Dearani AJ, Deschamps C. Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology. The Annals of Thoracic Surgery, 2013:96;1057-1061. DOI: 10.1016/j.athoracsur.2013.05.092
  • Takahashi T, Kumamaru M, Jenkins S, Saitoh M, Morisawa T, Matsuda H. In-patient step count predicts re-hospitalization after cardiac surgery. Journal of Cardiology, 2015:66(4);286-291. DOI: 10.1016/j.jjcc.2015.01.006
  • Green M, Marzano V, Leditschke IA, Mitchell I, Bissett B. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. Journal of Multidisciplinary Healthcare, 2016:9;247-256. DOI: 10.2147/JMDH.S99811
  • Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M, et al. Safety of patient mobilization and rehabilitation in the intensive care unit: systematic review with meta-analysis. Annals of the American Thoracic Society, 2017:14(5);766-777. DOI: 10.1513/AnnalsATS.201611-843SR
  • Doherty-King B, Yoon JY, Pecanac K, Brown R, Mahoney J. Frequency and duration of nursing care related to older patient mobility. Journal of Nursing Scholarship, 2013:46(1);20-27. DOI: 10.1111/jnu.12047
  • Kalisch JB, Tschannen D, Lee H, Friese CR. Hospital variation in missed nursing care. American Journal of Medical Quality, 2011:26(4);1-9. DOI: 10.1177/1062860610395929
  • Bittner NP, Gravlin G. Critical thinking, delegation, and missed care in nursing practice. The Journal of Nursing Administration, 2009:39(3);142-146. DOI: 10.1097/NNA.0b013e31819894b7
  • Vermişli S, Çam K. Ürolojik radikal cerrahi sonrası erken mobilizasyonun etkinliği. Bulletin of Urooncology, 2015:14;324-326. DOI: 10.4274/uob.467
  • Fiore Jr JF, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn S, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery-a randomized controlled trial. Annals of Surgery, 2017:266(2);223-231. DOI: 10.1097/SLA.0000000000002114
  • Gustafsson UO, Hausel J, Thorell A, Lijungqvist O, Soop M, Nygren J. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. The Archives of Surgery, 2011:146(5);571-577. DOI: 10.1001/archsurg.2010.309
  • Vlug MS, Bartels SAL, Wind J, Ubbink DT, Hollmann MW, Bemelman WA. Which fast track elements predict early recovery after colon cancer surgery? Colorectal Disease, 2012:14(8);1001-1008. DOI: 10.1111/j.1463-1318.2011.02854.x
  • Bergman S, Deban M, Martelli V, Monette M, Sourial N, Hamadani F, et al. Association between quality of care and complications after abdominal surgery. Surgery, 2014:156(3);632-639. DOI: 10.1016/j.surg.2013.12.031
  • Müller RG, Bundgaard-Nielsen M, Kehlet H. Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery. British Journal of Anaesthesia, 2010:104(3);298-304. DOI: 10.1093/bja/aep381
  • Akyolcu N. Ameliyat Sonrası Hemşirelik Bakımı. Akyolcu N, Kanan N, Aksoy G, editor. Cerrahi Hemşireliği I. 2. Baskı. İstanbul: Nobel Tıp Kitabevi;2017. p.335-364.
  • Hodgson CL, Capell E, Tipping CJ. Early mobilization of patients in intensive care: organization, communication and safety factors that influence translation into clinical practice. Critical Care, 2018:22(1);1-7. DOI: 10.1186/s13054-018-1998-9
  • Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Canadian Urological Association Journal, 2011:5(5);342-348. DOI: 10.5489/cuaj.11002
  • Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World Journal of Surgery, 2016:40(9);2065-2083. DOI: 10.1007/s00268-016-3492-3
  • Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer AL, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. International Journal of Gynecological Cancer, 2019:29(4);651-668. DOI: 10.1136/ijgc-2019-000356
  • Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong HCC, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World Journal of Surgery, 2016:40(10);2425-2440. DOI: 10.1007/s00268-016-3700-1
  • Wainwright TW, Gill M, McDonald AD, Middleton GR, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthopaedica, 2019:91(1);3-19. DOI: 10.1080/17453674.2019.1683790