IMPACT OF EARLY AMBULATION IN THE PEDIATRIC POSTOPERATIVE APPENDECTOMY PATIENT
Rationale: Extended immobilization has been shown to result in decreased function of the gastrointestinal and respiratory systems and delayed return to normal function. Scant literature is available addressing early ambulation for pediatric patients after appendectomy. In practice, we noted that patients are not routinely ambulated early in the immediate postoperative period.
Methods: Data was gathered from a retrospective review of 300 pediatric appendectomy patient charts at a children’s hospital. Information included: age, time of admission and discharge, time to ambulate, admitting unit, nausea and vomiting episodes, and pain medication given. Patients were divided into one of three groups based on the length of time before ambulation: less than 4 hours, 4 to 12 hours, and greater than 12 hours.
Results: Significantly fewer patients ambulated within 4 hours of surgery compared with both the group that ambulated between 4 and 12 hours postop and greater than12 hours postop (p <.001). Within each ambulatory group there were no significant differences in assigned acuity level. Patients who ambulated more than 12 hours after surgery had a significantly longer length of stay compared with patients who ambulated less than 4 hours postoperatively and patients who ambulated between 4 and 12 hours after surgery (p<.001, p<.001), although the patients in the latter two groups did not differ significantly. Only one patient who ambulated less than 4 hours postoperatively stayed in the hospital for 100 or more hours (2.5%), compared with 69 patients who took 12 hours or more to ambulate (44.5%). Patients in the more than 12 hour group most frequently experienced nausea and vomiting, with all three ambulatory groups significantly differing from each other (p<.001, p<.001, p<.001). Patients in the more than 12 hour group most often required pain medications of all types including acetaminophen, NSAIDs, and IV and PO narcotics. A multiple linear regression suggested that patients in the more than 12 hour group had a 34 hour longer length of stay, after adjusting for age, medication use, and nausea and vomiting (p<.001).
Implications for practice: The results of this research study suggest that early ambulation has a significant impact on length of stay in the pediatric postoperative appendectomy patient. Further research using a prospective intervention to promote early ambulation, evaluate the patient and family experience with early ambulation, and uncover barriers and obstacles to nurses pursuing early ambulation in the postoperative patient is planned. This will include development and evaluation of the effectiveness of education sessions on changing nurse perspective and prioritization of ambulation as an early nursing driven intervention to improve patient outcomes.