Patients Undergoing Laparoscopic Nephrectomy Walk Out From Operating Room After Surgery

Not Applicable

Recruiting

• Conditions: Enhanced Recovery After Surgery; Laparoscopic Nephrectomy
• Interventions: Behavioral: walk out from operating room

• Registration Number: NCT03960697
• Lead Sponsor: Sixth Affiliated Hospital, Sun Yat-sen University

Brief Summary

Early mobilization is considered as an important strategy to enhance postoperative recovery. However, direct association between very early mobilization and improved recovery needs randomized control trials to prove. This study proposes the program of walking out from operating room (WOFOR) after surgery, which means that encouraging patients to walk out from the operating room and return to the ward by walking under the condition of painlessness, clear consciousness and normal muscle strength of lower limb. The aim of this randomized controlled trial is to investigate the effect of WOFOR on the postoperative recovery of patients undergoing laparoscopic total and partial nephrectomy.

Detailed Description

Postoperative bed rest increases the risk of complications such as thromboembolism and intestinal adhesion. Encouraging early mobilization after surgery should be important, although actual effects of early mobilization still need randomized control trails to prove. The aim of this randomized controlled trial is to investigate the effect of walking out from operating room (very early mobilization after surgery) on the postoperative recovery of patients undergoing laparoscopic total and partial nephrectomy.

A sample size of 91 patients in each group will be selected by a prior power analysis on the basis of the following assumptions: (1) an absolute reduction in the length of the hospital stay by 1 day, (2) standard deviation 2 days, (3) α=0.05, (4) power 90% and .(5) missed follow-up rate 5%.

Patients will receive written and verbal information about the trial before written consent is obtained. The randomization will take place before the day of the surgery and the patients will be assigned to either intervention (return to ward by walking) or control group (return to ward by lying on the transporting bed ). A stratified randomization with three factors including sex, disease character and age will be performed to ensure an even spread. The randomization is performed using concealed allocation where envelopes are prepared externally using a randomization list prepared by a statistician.

The patients will receive general anesthesia combined with epidural analgesia. After surgery, the patients will be evaluated whether fulfilling the criteria for mobilization including stable physiological parameters, consciousness, normal level of orientation and muscle strength, and painlessness every ten minutes. If patients fulfill the criteria, they will receive different methods of returning to the ward based on the grouping. In the control group, the patient will return to the ward by lying on the transporting bed. In the intervention group, the patients will be raised to a sitting position for five minutes. If the patients do not complain any discomfort and have stable physiological parameters, they will be encouraged to stand. If standing do not cause any discomfort, they will be encouraged to walk within the range of 5-meter long and 60-centimeter wide. If patients can walk within the range, they will return to the surgical ward by walking under the protection of medical staffs.

Then, all study patients will be subject to the same management such as the guidance of drink and diet recovery, the guidance of mobilization in the ward (the duration and distance of walking in the ward will be recorded every day), nutrition supplement after surgery, and the criteria of drainage removal and hospital discharge. The outcomes such as the length of hospital stay after surgery will be recorded and analyzed to evaluate the effects of walking out from the operating room. The analysis of Intention-to-treat and Per-protocol-sets will be both performed by statisticians.

Study Timeline

• Study First Submitted: 2019-05-16
• Study First Submitted QC: 2019-05-20
• Study First Posted: 2019-05-23
• Study Start: 2019-06-04
• Status Verified: 2022-10
• Last Update Submitted: 2022-10-29
• Last Update Posted: 2022-11-01
• Primary Completion: 2023-08
• Study Completion: 2023-08

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 182

Inclusion Criteria

1. Age 18-65 Years old
2. scheduled for laparoscopic partial nephrectomy or laparoscopic total nephrectomy.
3. ASA grade I or grade II

Exclusion Criteria

1. Patients have severe cardiac diseases (cardiac function grading greater than grade 3/arrhythmia including sick sinus syndrome, atrial fibrillation, atrial flutter, atrioventricular block, frequent ventricular premature, multiple ventricular premature, ventricular premature R on T, ventricular fibrillation and ventricular flutter/acute coronary syndrome) or respiratory failure or hepatic failure or renal failure;
2. body mass index (BMI) ≥30 kg/m2
3. Patients have diabetics or patients with gastric emptying disorders;
4. Patients with poor blood pressure control (receive regular antihypertensive medical treatment but still have systolic blood pressure > 150 mmHg and/or diastolic blood pressure > 90 mmHg );
5. Patients have schizophrenia, epilepsy, Parkinson's disease, mental retardation, or hearing impairment.
6. Patients have thrombosis such as in lower extremity or in vena cava or in renal vein or in other veins.
7. Patients have neuromuscular disorders affecting lower limb activity, such as myasthenia gravis and cerebral infarction, which cause lower limb muscle weakness;
8. Patients have contraindications for epidural puncture.
9. Patients participate in other clinical trials.
10. Patients refuse to sign informed consent for research.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
walk out from operating room	walk out from operating room	patients will return to the ward after surgery by walking

Primary Outcome Measures

Name	Time	Method
Length of hospital stay after surgery	at hospital discharge(expected 6 days after surgery)	hospital stay time from operation completion to actual hospital discharge,

Secondary Outcome Measures

Name	Time	Method
Postoperative pain score	at 1-day, 2-day, 3-day, 4-day after surgery(up to 4 days after surgery)	Pain score after surgery is evaluated using a visual analogue scale 0-10 rated by the patients
Severity of postoperative nausea and vomiting	at 1-day, 2-day after surgery(up to 2 days after surgery)	Severity of postoperative nausea and vomiting is measured with the PONV intensity scale. Briefly, no PONV is defined as the absence of any emetic symptoms and nausea during the entire study period. Mild PONV is defined as the occurrence of mild nausea or one episode of vomiting if caused by an exogenous stimulus such as drinking or movement. Moderate PONV is reached when the patient vomits up to 2 times or experiences nausea that requires a rescue antiemetic therapy only once. Severe PONV is reached if the patient suffers more than two emetic episodes or needs more than one dose of a rescue antiemetic drugs.
Time to first defecation after surgery	at the time of the first defecation after surgery(expected average of 3 days after surgery)	the time length between operation completion and the first defecation
The percentage of patients feeling ready for hospital discharge when they reach the discharge criteria.	expected 6 days after surgery	The percentage of patients feeling ready for hospital discharge when they reach the discharge criteria.
Re-admission incidence within 30 days after operation	30 days after operation	Incidence of admit to hospital again within 30 days after operation
Postoperative recovery score using 40-item quality of recovery scoring system(QoR-40)	at 1-day, 2-day, 3-day, 4-day after surgery(up to 4 days after surgery)	To evaluate the postoperative recovery using 40-item quality of recovery scoring system including emotional state (9 items), physical comfort (12 items), physical independence (5 items), psychologic support (7 items), and pain (7 items). Each item is graded on a five-point Likert scale, and global scores range from 40 (extremely poor quality of recovery) to 200 (high quality of recovery).
Six-minute walking test	the day before surgery, and at 1-day, 2-day, 3-day, 4-day after surgery(up to 4 days after surgery	Physical capacity measured with the six-minute Walking test before surgery and after surgery.The longer walking distance in six minutes, the better physical capacity.
Anxiety score	the day before surgery, and at 1-day, 2-day, 3-day, 4-day after surgery(up to 4 days after surgery	Anxiety state evaluated by State-Trait Anxiety Inventory Form. The form used in this study is the Chinese version. The scales consist of 20 items; the responses range from 1 to 4 points (forced choice). The scores range from 20 (extremely low level of anxiety) to 80 (high level of anxiety). The STAI classifies anxiety into five stages: stages 1 and 2 suggest mild anxiety; stage 3 suggests moderate anxiety, and stages 4 and 5 suggest severe anxiety.
Time to fufill the criteria of hospital discharge (recovery time)	expected 6 days after surgery	The ideal time point for discharge, which is also considered as recovery time. The criteria for measuring recovery time included: 1) tolerance of diet and not necessary for intravenous nutrition; 2) analgesic-free, which is defined as visual analogue scale ≤3 without intravenous analgesic drugs, 3) adequate mobility; 4) afebrile status without major infectious complications
Time to first flatus after surgery	at the time of first exhaust after surgery(expected average of 2 days after surgery)	the time length between operation completion and the first flatus
Incidence of surgical complications within 30 days after surgery	30 days after surgery	Incidence of bleeding, wound infection, wound dehiscence within 30 days after surgery
The volume of drainage after surgery	expected average of 4 days after surgery	Total volume of drainage after surgery and drainage volume at 24-hour and 48-hour after the end of surgery.
Time to the removal of drainage tube	at the time of drainage removal(expected average of 4 days after surgery)	recorded the time length between operation completion and the removal of drainage tube
Incidence of major cardiovascular and cerebrovascular adverse events within 30 days after operation	30 days after surgery	Incidence of a complex event consisting of all-cause death, myocardial infarction, stroke and emergency target vessel revascularization within 30 days after surgery

Trial Locations

Locations (2)

the Sixth Affiliated Hospital, Sun Yat-sen University; 🇨🇳 Guangzhou, Guangdong, China

The sixth affiliated hospital,Sun Yat-sen University; 🇨🇳 GuangZhou, Guangdong, China