Artikel
Prospective clinical trial evaluating the impact on mobilization after major robotic urologic surgery: The MOVE trial
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Autoren
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Lukas Goms
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Tim Schiereck
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Stephan Degener
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Lisanne Holz
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Saher Dilshad
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Christina Karthaus
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Marie-Therese Hensen
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
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Malte Jacobsen
- Universitätsklinikum Aachen, Klinik für Kardiologie, Angiologie und Intensivmedizin, Aachen, Deutschland
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Lars Müller
- Heinrich-Heine-Universität Düsseldorf, Fakultät für Mathematik und Naturwissenschaften, Düsseldorf, Deutschland
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Friedrich-Carl von Rundstedt
- Helios Universitätsklinikum Wuppertal Universität Witten-Herdecke, Klinik für Urologie und Kinderurologie, Wuppertal, Deutschland
| Veröffentlicht: | 2. April 2025 |
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Gliederung
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Introduction: Ambulation after major surgery is essential for the length of stay after major surgery. At the same time mobilizing patients has the potential to reduce respiratory, gastrointestinal and thrombo-embolic complications. We have evaluated the impact of digitally based instruction videos on the mobility of patients in the postoperative setting and their impact on postoperative complications and the length of stay.
Material and methods: We randomly assigned, in a 1:1 ratio, patients after major robotic surgery to digitally based instruction videos for mobilization instructions using tablet computers versus standard of care (encouragement to ambulate by surgeons and nursing staff). A total of 340 patients were randomized. Baseline activity was measured by PASE scores. Patient activity and vital signs were monitored with CE activity trackers. Clinical data and complications were recorded for the 30-day postoperative period. The primary outcome was physical activity. Secondary endpoints were length of stay, postoperative complications correlated with changes in vital signs.
Results: 340 eligible patients were randomly assigned to digital instruction videos (168) versus simple encouragement to ambulate (172). Median age of patients was 66 years. Median Length of Stay was 5 days. The preoperative PASE score was 122 and 136 in the control group. Patient in the interventional group showed initially higher activity scores and POD 1 and 2 but there was no significant difference detected. There was no significant difference in overall physical activity between the two groups over the course of the hospital stay. By assessment of the activity trackers the heart rate and respiratory rate decreased continuously over the course of the hospital stay. Heart rate variability as a sign of physical recovery was increased respectively. This gradual change of HR and HRV was not detected in patients with surgical or genitourinary complications.
Conclusion: As compared to encouragement to ambulate as standard of care, the use of instruction videos for postoperative mobilization did not lead to a measureable improvement in physical activity or a reduction of postoperative complications. The length of stay was significantly reduced in patients undergoing robotic kidney surgery. Variations in vital signs were associated with defined complication clusters.
