A service evaluation exploring postoperative ambulation following thoracic surgery

Purpose

Early ambulation following thoracic surgery is important to help to reduce the risk of postoperative pulmonary complications, reduce hospital length of stay and is a key component of the Enhanced Recovery after Surgery pathway.

Postoperative ambulation following thoracic surgery however can be limited by various factors including the presence of chest drains that are essential for the removal of air and fluid that collects in the chest.

The primary aim of the service evaluation was to explore when individuals first ambulated postoperatively following thoracic surgery. The secondary aims were to explore why individuals did not ambulate day 1 postoperatively and whether any factors were associated with day first ambulated postoperatively.

Exploring when individuals first ambulate postoperatively and whether any factors influence this may help to identify ways of facilitating earlier postoperative ambulation helping to innovate the rehabilitation of individuals following thoracic surgery.

Approach

Data collection was for 12 months between 1st July 2015 and 30th June 2016 for all individuals following thoracic surgery referred to physiotherapy.

Data was collected retrospectively using information from physiotherapy ward sheets, chest radiographs and an electronic patient records system.

Data was analysed using medians and quartiles for day first ambulated postoperatively data (Day 0 was day of the surgery).

A Poisson regression model was used to explore factors associated with day first ambulated postoperatively

Outcomes

Data was obtained for 367 individuals who received physiotherapy following thoracic surgery between 1st of July 2015 and 30th June 2016.

Median day first ambulated postoperatively was day 3. The main reasons reported for individuals not ambulating day 1 postoperatively were chest drains requiring continuous wall suction (232 individuals) and cardiovascular instability (30 individuals).

Age, chest drain duration and type of incision had a statistically significant association with day first ambulated postoperatively. For each year older an individual was day to first ambulation postoperatively increased by 0.5% (95% CI 1.001-1.009 p=0.021).

For each extra day the drain(s) stayed in, day to first ambulation postoperatively increased by 3.4% (95% CI 1.023-1.045 p=< 0.0001).

Undergoing a Video-assisted thoracoscopic surgery (VATS) incision reduced day to first ambulation postoperatively by 16.6% compared to thoracotomy incision (95% CI 0.734-0.947 p=0.005).

Median day first ambulated postoperatively following thoracic surgery was day 3. The main reasons reported for individuals' not ambulating day 1 postoperatively were chest drains being on suction and cardiovascular instability.

Increased age and longer chest drain duration were associated with later postoperative ambulation. VATS incision was associated with earlier postoperative ambulation. It is worth exploring whether digital portable drains with inbuilt suction could be trialled to facilitate earlier postoperative ambulation.


Limitations included data being retrospectively collected from physiotherapy ward sheets rather than prospectively from medical notes and the possibility that individuals ambulated prior to ambulating with physiotherapists.

Implications

Median day first ambulated postoperatively following thoracic surgery was day 3.
The main reason reported for individuals' not ambulating day 1 postoperatively was chest drains being on suction.


Longer chest drain duration and increased age were associated with later postoperative ambulation. VATS incision was associated with earlier postoperative ambulation.

Funding acknowledgements

This work was unfunded

Additional notes

This work was presented at Physiotherapy UK 2019