Effect of Early Postoperative Mobilization on Functional Recovery, Hospital Length of Stay, and Postoperative Complications After Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects: A Prospective, Randomized Controlled Trial.

Autor: Lima de Araujo CA; Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. caio.araujo@hc.fm.usp.br., de Freitas Busnardo F; Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Thome Grillo VA; Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Chirnev Felício CH; Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Antônia de Almeida LA; Serviço de Reabilitação do Instituto do Câncer do Estado de São Paulo do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil., Sparapan Marques CF; Divisão de Cirurgia do Aparelho Digestivo e Coloproctologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Nahas CS; Divisão de Cirurgia do Aparelho Digestivo e Coloproctologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Imperialle AR; Divisão de Cirurgia do Aparelho Digestivo e Coloproctologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Gemperli R; Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Ribeiro U Jr; Divisão de Cirurgia do Aparelho Digestivo e Coloproctologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov 18. Date of Electronic Publication: 2024 Nov 18.
DOI: 10.1245/s10434-024-16497-x
Abstrakt: Background: Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5 days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients.
Methods: This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3 m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life.
Results: On day 5, EM improved ambulation significantly compared with BR (68.0% vs 38.5%; P = 0.035) and achieved greater 6MWT distances on days 5 (108.78 vs 47.73 m; P = 0.041) and 30 (243.8 vs 166.29 m; P = 0.018). The EM patients were discharged earlier (66.7% by day 10 vs 33.3% of the BR patients; P = 0.043), with comparable healing times (P = 0.06) and postoperative complication rates (68% vs 80.8%; P = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups.
Conclusion: Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications.
Competing Interests: Disclosures There are no conflicts of interest.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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