Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: A prospective observational study

Michaël Finet (1) , Alice Bellicha (2) , Edouard Sage (3) , Matthieu Glorion (4) , Titouan Kennel (5) , Mathilde Labro (5) , Bernard Trillat (5) , Marc Fischler (1) , Alexandre Vallée (5) , Morgan Le Guen (1) , Julien Fessler (1)

1 Service d'anesthésiologie et de médecine de la douleur
2 CRESS - U1153 - Equipe 3: EREN- Equipe de Recherche en Epidémiologie Nutritionnelle
3 Chirurgie thoracique et transplantation pulmonaire
4 Chirurgie thoracique et transplantation pulmonaire
5 Département Épidémiologie - Data – Biostatistiques

Study objective: Postoperative physical therapy and early mobilization are major elements for enhanced recovery after surgery. In contrast with supervised physical therapy sessions that can be monitored, self-mobilization is not easily quantifiable and has so far been estimated mainly through patient auto-reports. This study aimed to perform a comprehensive and objective evaluation of postoperative mobility. Design: Prospective observational study. Setting: Postoperative setting. Patients: Patients undergoing mini-invasive lung surgery. Interventions: Measurement of postoperative mobility during the first five postoperative days using an acceler- ometer (ActiGraph GT3X). Measurements: The primary outcome was the number of daily steps. Secondary outcomes included physical ac- tivity duration and intensity, sedentary time, number of breaks in sedentary time, sedentary patterns, daily evaluation by physiotherapists, postoperative complications, and acceptability of wearing the accelerometer. Main results: Sixty patients were included in the study, of whom 56 provided at least one day of valid accel- erometry data. There was no significant change during the first four PODs concerning the number of daily steps nor the mean cadence. One-minute cadence peak, total activity counts, and duration of light-intensity physical activity increased over time (p = 0.032, p = 0.001 and p = 0.001, respectively). Sedentary patterns changed favorably over time, with a decrease in prolonged sedentary bouts (≥ 60 consecutive min) (p < 0.001), and an increase in shorter bouts (< 10 min) (p ¼ 0.001). Similar results were observed when analysis was adjusted for the day of the week when the surgery took place. The median acceptability of wearing the accelerometer was excellent (median 10 [9-10] on a 10-point Likert scale). Three patients had major complications. Conclusions: Our findings suggest that daily steps may not be the only relevant indicator of early mobility following thoracic surgery and that accelerometry is suitable to follow patients’ early postoperative activity.

Keywords: Thoracic surgery; Video-assisted; Robotic surgical procedures; Exercise; Accelerometry; Actigraphy; Early ambulation; Postoperative complications

Domains: Life Sciences [q-bio]; Surgery; Pulmonology and respiratory tract

Michaël Finet, Alice Bellicha, Edouard Sage, Matthieu Glorion, Titouan Kennel, et al.. Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: A prospective observational study. Journal of Clinical Anesthesia, 2023, 86, pp.1-8. ⟨10.1016/j.jclinane.2022.111048⟩. ⟨hal-04093919⟩