Effects of Walking Out From Operating Room on Postoperative Recovery of Patients Undergoing Laparoscopic Radical Gastrectomy
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Laparoscopic Radical Gastrectomy
- Sponsor
- Sixth Affiliated Hospital, Sun Yat-sen University
- Enrollment
- 200
- Locations
- 1
- Primary Endpoint
- Length of hospital stay after surgery
- Status
- Recruiting
- Last Updated
- 3 years ago
Overview
Brief Summary
Although early and progressive mobility is widely accepted as an important aspect of postoperative care, guidelines and recommendations suggesting the exact timing and intensity of mobilization efforts are nonexistent. We propose the concept of walking out from the operating room (WOFOR), which means under meticulous anesthesia treatment, perfect postoperative analgesia conditions, rigorous assessment of consciousness and normal muscle strength, postoperative patients can walk safely out of the operating room and return to the ward. The aim of this randomized controlled trial is to investigate the effect of walking out from the operating room on the postoperative recovery of patients undergoing laparoscopic radical gastrectomy.
Detailed Description
Postoperative bed rest increases the risk of complications such as thromboembolism and intestinal adhesion, but actual clinical 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 the operating room (very early mobilization after surgery) on the postoperative recovery of patients undergoing laparoscopic radical gastrectomy. A sample size of 96 patients in each group is calculated 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 deviations are 2 days in the experimental group and the control group, (3)α=0.05, (4) power 90% and (5) missed follow-up rate 10%. Considering that this study is not for rare diseases, in order to ensure adequate sample size, we adjust the sample size of each group to an integer of 100. Patients will receive written and verbal information about the trial before written consent is obtained. The randomization will take place when the surgeons confirm preliminarily there is no need to place drainage tube for coelom hyperthermia perfusion after laparoscopy. Then 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, age and total or distal gastrectomy 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, 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.
Investigators
SanQing Jin
professor
Sixth Affiliated Hospital, Sun Yat-sen University
Eligibility Criteria
Inclusion Criteria
- •Age 18-65 Years old
- •scheduled for laparoscopic radical gastrectomy.
- •American Society of Anesthesiologists (ASA) grading I or II
Exclusion Criteria
- •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;
- •Body mass index (BMI) ≥30 kg/m2;
- •Preoperative hemoglobin\<80 g/L or albumin\<30 g/L
- •Patients have diabetics or patients with gastric emptying disorders;
- •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 );
- •Patients have schizophrenia, epilepsy, Parkinson's disease, mental retardation, or hearing impairment.
- •Patients have thrombosis such as in lower extremity or in vena cava or in other veins.
- •Patients have neuromuscular disorders affecting lower limb activity, such as myasthenia gravis and cerebral infarction, which cause lower limb muscle weakness;
- •Patients have contraindications for epidural puncture.
- •Postoperative placement of drainage tube for coelom hyperthermia perfusion
Outcomes
Primary Outcomes
Length of hospital stay after surgery
Time Frame: at hospital discharge(expected 7 days after surgery)
hospital stay time from operation completion to actual hospital discharge
Secondary Outcomes
- Anxiety score(the day before surgery, every 24 hours after surgery (at 1-day, 2-day, 3-day), and then every 48 hours until the discharge after surgery (at 5-day, 7-day (if any), 9-day (if any)...))
- Severity of postoperative nausea and vomiting(every 24 hours after surgery (at 1-day, 2-day, 3-day))
- Unplanned re-admission incidence within 30 days after operation(30 days after operation)
- The percentage of patients feeling ready for hospital discharge when they reach the discharge criteria.(expected 6 days after surgery)
- Postoperative recovery score using 40-item quality of recovery scoring system(QoR-40)(every 24 hours after surgery (at 1-day, 2-day, 3-day), and then every 48 hours until the discharge after surgery (at 5-day, 7-day (if any), 9-day (if any)...))
- Time to first flatus after surgery(from the time of operation completion until the time of the first flatus occurrence, assessed up to 7 days.)
- Time to fulfill the criteria of hospital discharge(expected 7 days after surgery)
- Six-minute walking test(the day before surgery, every 24 hours after surgery (at 1-day, 2-day, 3-day), and then every 48 hours until the discharge after surgery (at 5-day, 7-day (if any), 9-day (if any)...))
- Postoperative pain score(every 24 hours after surgery (at 1-day, 2-day, 3-day), and then every 48 hours until the discharge after surgery (at 5-day, 7-day (if any), 9-day (if any)...))
- Incidence of surgical complications within 30 days after surgery(30 days after surgery)
- Time to first defecation after surgery(from the time of operation completion until the time of the first defecation occurrence, assessed up to 10 days.)
- Incidence of major cardiovascular and cerebrovascular adverse events within 30 days after operation(30 days after operation)
- Time to the removal of drainage tube(from the time of operation completion until the time of drainage tube removal, assessed up to 30 days.)
- The volume of drainage after surgery(every 24 hours from the time of operation completion until the time of drainage tube removal, assessed up to 30 days.)
- Incidence of surgical complications within 7 days after surgery(7 days after surgery)