Monday, April 16, 2012

Some Patients Do Not Walk after Surgery Despite Encouragement

Loyola study sheds light on obstacles to walking following gynecologic surgery

MAYWOOD, Ill. -- Despite the well-documented benefits of walking after surgery, some patients are reluctant to make an attempt even with the encouragement of medical staff. Loyola University Health System researchers reported these findings at the prestigious 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons in Baltimore.

Loyola researchers set out to determine if a program that encourages patients to walk after surgery had a positive effect. However, the study revealed that patients who were encouraged to walk actually recorded of median of 80 steps while those who received routine care without encouragement took 87 steps. Also, 12 percent of patients in the study did not walk at all during their hospital stay.

“There are many obstacles that can prevent a patient from moving after surgery,” said Maike Liebermann, MD, co-investigator, LUHS. “If a patient cannot walk, this can increase the risk of complications and prolong recovery time and length of hospital stay."

Obstacles to walking can include pain, catheters or drains, hospital gowns, IVs and lack of assistance. While further research is needed, the authors found that early discontinuation of catheters and IV fluids and improvement in pain management have the potential to increase walking and overall outcomes for patients after gynecologic surgery.

This study measured steps taken in the 24 hours prior to a patient going home from the hospital. Researchers evaluated 146 patients who underwent gynecologic surgery who either had routine care with no encouragement to walk or a goal-oriented walking program following surgery. The latter group had signs at the bedside to instruct the health-care providers to encourage the patient to take at least 500 steps prior to discharge. Steps were recorded using a pedometer.

“This was the first study to measure walking after surgery in gynecologic patients,” said Michael Awad, MD, study co-investigator, LUHS. “It demonstrated an easy way for doctors to evaluate a patient’s ability to walk and decide if the patient is ready to go home from the hospital."

For most patients, walking after surgery is a requirement before they are allowed to leave the hospital. However, there is no guideline to determine the adequate amount of walking after surgery.

The authors concluded that further research must be done to establish standards for walking after gynecologic surgery. They reported that one consideration may be to treat walking as another vital sign, so that it is reported regularly.
Loyola study authors also included Megan DeJong, MD; Colleen Rivard, MD; Jim Sinacore, PhD; and Linda Brubaker, MD, MS.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.