Construction And Application Of Early Mobilization Protocol For Colorectal Surgery In Enhanced Recovery After Surgery

BackgroundColorectal cancer is one of the most common malignant tumors of the digestive system in China,and minimally invasive surgery is currently the preferred treatment for colorectal cancer.In recent years,the introduction of the concept of enhanced recovery after surgery has brought great benefits to patients,one of the most critical measures being early mobilization after surgery,which can reduce the occurrence of complications such as pneumonia and deep vein thrombosis,and is of great significance in promoting the recovery of gastrointestinal function.However,there are no specific recommendations recommended in the current guidelines.There are no uniform standards for the definition of exercise concept,arrangement of postoperative exercise plan,and determination of exercise levels,resulting in extremely low compliance of patients with early postoperative exercises and seriously affects patients’early functional recovery after surgery.Therefore,formulating safe and feasible standardized measures to improve patients’compliance with early postoperative exercises,reduce postoperative complication rate,and promote early recovery of patients are current clinical problems that urgently need to be resolved.ObjectiveConstructed an early mobilization protocol for radical colorectal cancer surgery patients under the concept of enhanced recovery after surgery(ERAS),and verified the effectiveness and safety of the program through clinical application,in order to improve patient compliance with exercises after surgery,shorten the recovery time of gastrointestinal function,reduce postoperative complications,and provide a scientific theoretical basis for clinical promotion and application.Methods1.Protocol construction Under the guidance of the concept of enhanced recovery after surgery(ERAS),the evidence-based method is used to search the database for research Group discussion,preliminary draft of the early mobilization protocol for colorectal surgery patients were drafted,and the early mobilization protocol was modified,supplemented and perfected by Delphi expert correspondence method,and finally formed an early mobilization protocol for colorectal surgery patients.2.Protocol application The patients who underwent laparoscopic radical resection of colorectal cancer in a tertiary first-class hospital in Henan Province were randomly divided into study group and control group.Both groups implemented ERAS care during the perioperative period,and the observation group implemented an early postoperative exercise protocol constructed on the basis of the control group.The two groups of patients were compared in terms of time to first exhaust,time to first defecation,the length of postoperative hospitalization,the incidence of postoperative complications,the rate of getting out of bed within 24 h after the operation,the time to first getting out of bed,and the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),number of steps,distance of exercise,sleep duration,Visual Analogue Scale/Score(VAS),and general comfort questionnaire(GCQ),and the incidence of adverse events,and the data collected were statistically analyzed by SPSS 26.0 software.Results1.Protocol construction:Based on the concept of evidence-based medicine and two rounds of Delphi expert correspondence,an early mobilization program for patients after radical colorectal cancer surgery was constructed,including 2 primary entries for preoperative care and postoperative management;7 secondary entries for empowerment education,psychological preparation,aerobic exercise,and progressive resistance exercise,and 23 tertiary entries.Two rounds of experts are more enthusiastic in this research,the degree of expert authority(Cr)were 0.957,and the coordination coefficient(W)of the two rounds of experts were 0.199 and 0.451,respectively,which were statistically significant(P<0.001).2.Clinical application(1)Comparison of postoperative exercise compliance and rehabilitation indicators:The postoperative exercise compliance of the study group was significantly higher than that of the control group,and the difference was statistically significant(χ~2=67.141,P<0.001);the length of postoperative hospitalization,time to first discharge from bed,and time to first defecation were significantly earlier in the study group than in the control group(P<0.001).(2)Changes in postoperative mobilization steps and mobilization distance:the mobilization steps and mobilization distance of the two groups of patients in the Postoperative day 1(POD1),Postoperative day 2(POD2)and Postoperative day 3(POD3)with a significant difference in time change,showed a trend of significant increase,and the difference was statistically significant(P<0.001).During the implementation of the early activity program,no adverse activity events occurred and it was safe and feasible.(3)VAS scores:There was no difference in preoperative VAS with the two groups(t=0.324,P>0.05),and postoperative VAS showed a significant difference over time,with a decreasing trend,and the difference was statistically significant(P<0.001).(4)GCQ scores:There was no significant difference in preoperative GCQ score between the two groups(t=0.757,P>0.05),and the postoperative GCQ scores showed a significant difference with time change and a decreasing trend,the difference was statistically significant(P<0.001).(5)Postoperative sleep duration:The sleep duration in POD1,POD2 and POD3 of the two groups showed a significant trend of increase,and the difference was statistically significant(P<0.001).(6)Perioperative SAS and SDS scores:There was no difference in the preoperative SAS and SDS scores with the two groups(t=1.495,P>0.05;t=1.130,P>0.05).The scores of SAS and SDS were lower than those before operation,and the study group was significantly lower than the control group(t=24.718,P<0.001;t=18.160,P<0.001).(7)Postoperative complication rate:The total number of postoperative complications between the two groups was significantly different(P<0.001);the number of cases of postoperative fever,nausea and vomiting,dizziness,urinary retention and water-electrolyte disorders in the study group was less than that of the control group(P>0.05);but the incidence of postoperative abdominal distension and ineffective sputum evacuation in the study group was significantly lower than that of the control group(P<0.05).Conclusions1.Under the guidance of the concept of enhanced recovery after surgery,an early mobilization protocol for patients after radical colorectal cancer surgery was constructed through evidence-based medicine and the Delphi method.2.The protocol is safe,feasible,scientific and reliable,improves patient compliance with activities,shortens postoperative recovery time,reduces postoperative hospital stay,reduces the incidence of postoperative complications,relieves patients’bad mood after surgery,and promotes early postoperative recovery.