From the Guidelines
Early ambulation in ERAS principles means getting patients out of bed and walking as soon as possible after surgery, ideally with the patient sitting out of bed for 30 minutes on day 0 and 6 hours/day thereafter, and commencing walking on day 1. This practice involves having patients sit up, stand, and walk progressively increasing distances with appropriate assistance from healthcare staff. The process typically begins with sitting at the edge of the bed, then standing, and finally walking short distances in the room or hallway, gradually increasing activity as tolerated. Early ambulation is implemented using a structured approach with specific mobility goals for each postoperative day, often tracked using step counts or distance measurements. This practice helps prevent complications like blood clots, pneumonia, and muscle weakness while promoting faster return of bowel function and reducing length of hospital stay. The physiological benefits include improved circulation, enhanced pulmonary function, reduced insulin resistance, and prevention of muscle atrophy. Healthcare teams should ensure adequate pain control before mobilization attempts, using multimodal analgesia strategies that minimize opioid use, as excessive pain or sedation can hinder mobility efforts. Patients should be educated preoperatively about the importance of early movement and what to expect after surgery to increase compliance with ambulation protocols 1.
Some of the key benefits of early ambulation include:
- Reduced risk of postoperative thromboembolism and pulmonary complications
- Improved circulation and enhanced pulmonary function
- Reduced insulin resistance and prevention of muscle atrophy
- Faster return of bowel function and reduced length of hospital stay
- Improved overall patient outcomes and reduced morbidity and mortality
It is essential to note that while the evidence for the direct benefits of early mobilization is limited, the negative effects of prolonged bed rest are well established, and early ambulation is a crucial component of ERAS protocols 1. Therefore, healthcare teams should prioritize early ambulation as a key component of perioperative care to improve patient outcomes.
In terms of implementation, early ambulation should be tailored to the individual patient's needs and abilities, with a focus on progressive mobilization and gradual increase in activity levels. Healthcare teams should work together to ensure that patients receive adequate pain control, education, and support to facilitate early ambulation and promote optimal recovery 1.
From the Research
Definition of Early Ambulation in ERAS Principles
- Early ambulation refers to the practice of getting patients to move and walk as soon as possible after surgery, with the goal of improving their overall recovery and reducing complications 2, 3, 4, 5.
- The ERAS principles emphasize the importance of early mobilization as a key element in enhancing recovery after surgery, with benefits including reduced length of stay, improved pain control, and decreased risk of readmission 6, 3, 5.
Implementation of Early Ambulation in ERAS Protocols
- Studies have shown that early ambulation can be achieved through the implementation of ERAS protocols, which include elements such as multimodal pain management, limited opioid use, and early removal of drains and tubes 3, 4, 5.
- The ERAS Society provides guidelines and recommendations for the implementation of ERAS protocols, including early ambulation, in various surgical specialties 6, 5.
- Research has demonstrated that early ambulation is associated with improved outcomes, including shorter length of stay, reduced complications, and decreased readmissions 3, 4, 5.
Key Aspects of Early Ambulation in ERAS
- Early ambulation is often defined as ambulation within the first hour post-extubation or on the first postoperative day 2, 4.
- The distance ambulated can vary, but a benchmark distance of 250 feet has been used in some studies 2.
- Early ambulation is often combined with other ERAS elements, such as multimodal pain management and limited opioid use, to enhance recovery and reduce complications 3, 4, 5.