Y. A. Ghazi3, T. W. Stethen2, R. E. Heidel4, B. J. Daley1, L. G. Barnes4, J. M. McLoughlin1 1University Of Tennessee Medical Center,Surgery,Knoxville, TN, USA 2University Of Tennessee Health Science Center,Graduate School Of Medicine,Memphis, TN, USA 3University Of Tennessee,Biology,Knoxville, TN, USA 4University Of Tennessee Graduate School Of Medicine,Knoxville, TN, USA
Introduction: ~~Enhanced recovery after surgery (ERAS) principles have recently been introduced in abdominal ventral hernia surgery. Early ambulation after surgery has been demonstrated to reduce complications and decreases length of stay (LOS). This study evaluated the impact of missed and refused ambulation attempts on LOS among those undergoing abdominal hernia repair.
Methods: ~~From January 2014–December 2015, all patients who had undergone elective abdominal hernia repair were assigned a dedicated ambulation team with the goal of ambulating three times per day. Clinical data was collected prospectively and compared to similar cohorts from 2010 – 2013. Statistical analysis of ambulation frequency, percentage of sessions completed and overall LOS was performed using Mann-Whitney U and Spearman’s rho.
Results: ~~A total of 79 patients were analyzed undergoing a total of 82 hernia repairs. The age range was from 20 to 85 with a mean age of 60. All patients were ambulatory prior to surgery. There were 74 laparoscopic abdominal procedures and 8 open abdominal procedures. The overall median LOS for all patients was 1.9 days. When ambulation did not occur for 24 hours, the median LOS increased from 1.4 days to 4.0 days (p < .001). When patients refused to ambulate, the median LOS increased from 1.3 days to 4.1 days (p < .001). As missed ambulation events increased for any reason, LOS increased (r = 0.3, p = .008).
Conclusion: ~~A dedicated ambulation team with three times a day ambulation reduced LOS for those undergoing abdominal hernia repairs. Failure to ambulate had a significant impact on increasing length of stay. Investment in a dedicated ambulation team as well as emphasis on a daily ambulation regimen is effective in reducing cost for ventral hernia surgery.
