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Patients who were more mobile in the first 48 hours after major elective surgery had a lower risk of complications than those who stood or walked less, a retrospective study found.

Every 4 minutes of mobilization was linked with a lower risk for a composite of postoperative complications (HR 0.75, 95% CI 0.67-0.84, P<0.001) and with shorter hospital stays (median 0.12 fewer days, 95% CI 0.09-0.15, P<0.001), Alparslan Turan, MD, of the Cleveland Clinic in Ohio, and co-authors reported in .

Of 8,653 postoperative patients, mobilization occurred for a median of 3.2 minutes per hour for those who had a complication -- myocardial injury, ileus, stroke, venous thromboembolism, pulmonary complications, or all-cause in-hospital mortality -- compared with 4.1 minutes for those who did not, Turan and co-authors said.

Overall, 7.3% of the total sample experienced the composite outcome. No association was seen between mobilization and lower pain scores or reduced 30-day readmissions.

"The results are presumably generalizable because we included a broad spectrum of inpatients with various comorbidities who had various types of surgery," the researchers wrote.

The median mobilization time in the study was 1.6 hours per day. This was less than the recommended Enhanced Recovery After Surgery () protocols, although times specified in various ERAS pathways are not evidence based, Turan and co-authors pointed out. Moreover, "current recommendations are largely based on expert opinion," with little objective quantification of mobilization, they said.

Wearable accelerometers made this study possible, the researchers added, noting that a also found a roughly similar amount of postsurgical mobilization.

"There has been surprisingly little evidence that mobilization improves outcomes," observed Martin Almquist, MD, PhD, of Skåne University Hospital in Lund, Sweden, in an .

"It is difficult, and perhaps unethical, to randomize patients to mobilize little or a lot," he wrote. "Thus large-scale observational data, such as those used in the present study, have an important role in filling the knowledge gap."

Though the research doesn't show causality, the findings offer surgeons and staff "a strong argument to persuade their patients to get out of bed, potentially reducing their risk of unpleasant and dangerous complications," Almquist added.

The study assessed people with a mean age of 58, and just over half (52.4%) were female. Participants had non-cardiac elective surgery that lasted more than 2 hours between February 2017 and October 2020, followed by at least 48 hours of hospitalization. Musculoskeletal and digestive system surgeries were most common.

At least 12 hours of activity were monitored by accelerometers during the first 48 hours after surgery. Patients were considered mobilized when they were upright (standing) or walking. Findings were adjusted for multiple confounders, including age, sex, type of surgery, and comorbidities.

Limitations included the study's retrospective design, the researchers acknowledged. Analyses were limited to the type and quality of data available in medical records.

Importantly, unknown confounders may have influenced results. "Specifically, sicker patients are likely to ambulate less than those who are recovering well," Turan and co-authors wrote. "They are also more likely to experience complications, but not necessarily because of inadequate ambulation." In addition, reverse causation may have occurred.

"Only a randomized clinical trial will identify the fraction of mobilization benefit that is causal and thus amenable to intervention," Turan and colleagues noted. "Our data suggest that a trial would be well worth conducting, challenging as it may be."

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