The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients.

Autor: Pederson JL; Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada., Padwal RS; Division of General Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.; Alberta Diabetes Institute, Edmonton, Alberta, Canada., Warkentin LM; Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada., Holroyd-Leduc JM; Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada., Wagg A; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada., Khadaroo RG; Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.; Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Nov 06; Vol. 15 (11), pp. e0241554. Date of Electronic Publication: 2020 Nov 06 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0241554
Abstrakt: Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as 'delayed' (≥36h) or 'early' (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were 'vulnerable-to-moderately-frail', according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9-35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99-5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91-3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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