JMIR Publications

ABSTRACT

Background:

It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization.

Objective:

We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery.

Methods:

We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors and evaluated their effects on outcomes after major abdominal surgery. We excluded studies involving subjects younger than 18 years. Risk of bias was assessed using RoBANS for observational studies and RoB 2 for randomized controlled trials. Findings were summarized by qualitative synthesis.

Results:

We identified 15 studies. Risk of bias was high in all but one study. Twelve studies (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome. In observational studies (n=9), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In randomized controlled trials (n=6), only one study demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when mobility-enhancing intervention was compared with usual care. Notably, mobility interventions used in 4 out of 6 randomized controlled trials did not result in increased postoperative physical activity.

Conclusions:

Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, randomized controlled trials have not proved the benefit of mobility-enhancing interventions compared with usual care. Future research would benefit from improving study designs, increasing methodologic rigor, and measuring physical behaviors beyond step counts (such as static positioning and in-bed activities) to understand the impact of postoperative mobilization on outcomes after major abdominal surgery.