Is postoperative ambulation a component or a marker of enhanced recovery after surgery?
Letter to the Editor

Is postoperative ambulation a component or a marker of enhanced recovery after surgery?

Karem Slim1,2

1Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France; 2Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France

Correspondence to: Karem Slim. Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France. Email: kslim@chu-clermontferrand.fr.

Submitted Jan 12, 2019. Accepted for publication Jan 22, 2019.

doi: 10.21037/jgo.2019.01.29


I read with interest the excellent paper by Dr. Stethen et al. (1). The authors should be congratulated for their work. They concluded that ambulation participation is a critical component of enhanced recovery programmes (ERPs) and that it is associated with better outcomes. But in our opinion (2), postoperative ambulation is also a marker of the success of ERPs. Since there are, in this setting, many confounding factors, one cannot state, whether the patients ambulate well because they are free of pain, nausea and vomiting, intravenous perfusion, or postoperative complications or alternatively whether their postoperative course improves because they ambulate early and actively. That is what we have described as “the egg-and-chicken situation in ERPs”. It would be interesting, in this study (1) to know why some patients refused to walk: because they complained of significant pain, or nausea and vomiting or others postoperative factors?

Without these data, we cannot exclude that early ambulation (as well as early feeding) is in fact a marker of ERPs and a good postoperative course rather than a true postoperative component of ERPs. A given well-informed patient, who feels well after surgery, is always willing to walk and to leave his bed.


Acknowledgements

None.


Footnote

Conflicts of Interest: The author has no conflicts of interest to declare.


References

  1. Stethen TW, Ghazi YA, Heidel RE, et al. Walking to recovery: the effects of missed ambulation events on postsurgical recovery after bowel resection. J Gastrointest Oncol 2018;9:953-61. [Crossref] [PubMed]
  2. Slim K, Joris J. The egg-and-chicken situation in postoperative enhanced recovery programmes. Br J Anaesth 2017;118:5-6. [Crossref] [PubMed]
Cite this article as: Slim K. Is postoperative ambulation a component or a marker of enhanced recovery after surgery? J Gastrointest Oncol 2019;10(3):572. doi: 10.21037/jgo.2019.01.29