The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients

Abstract

The aim. To determine the impact of implementing the extra early mobilization protocol (EEM) on the length of intensive care unit (LICU) stay and postoperative unit (LPOU) stay and to assess the role of age, heart contractility, functional class and surgical outcomes. Materials and methods. Participants – adult patients of 2018–2019 with less than 24-hour artificial lung ventilation (ALV). The first group were treated according to the early mobilization protocol (EM, patients of 2018); the second group were treated according to the EEM protocol (patients of 2019). Design: a retrospective analysis. Settings: cardiosurgical unit. Interventions: the major difference is that the resources of patient mobilization team have expanded since 2019, namely it included a physical therapist, which made it possible to modify the EM protocol (standing on the 2 postoperative day (POD), activation with the help of medical staff, respiratory exercise) to the EEM protocol (standing on the 1 POD following consultation with an anesthesiologist, exercises with a physical therapist, respiratory exercise). The main outcomes: LICU, LPOU and total postoperative hospitalization (LTPO) (number of nights). Results. There were no differences between the EEM and EM groups in LICU (3 (2; 4) vs. 2 (2; 4); P = 0.182), LPOU (7 (6; 10) vs. 8 (6; 10); P = 0.118), LTPO (10 (8; 13) vs. 10 (9; 13); P = 0.308). Correlation analysis revealed absence, weak and very weak relations between the LICU, LPOU, LTPO indicators and other criteria, including age, ejection fraction, ALV. Conclusions. The effectiveness of the EEM protocol seems doubtful to reduce LICU, LPOU, and LTPO as compared to the EM protocol. The obtained results also raise the importance of physical therapist time management.