Development of an early mobilization protocol for patients following hepatectomy and its effect on rehabilitation outcomes

Table 1 Comparison of baseline characteristics, n (%)

Group	n	Sex	Age (years)	BMI (kg/m2)	ASA classification II
		Male	Female
Intervention group	100	58 (58.0)	42 (42.0)	57.32 ± 7.83	23.84 ± 2.26
Control group	100	60 (60.0)	40 (40.0)	56.62 ± 7.91	23.59 ± 2.34
χ2/t value	-	0.081	0.624	0.793	0.382
P value	-	0.776	0.533	0.429	0.826

BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Early postoperative activity program for hepatectomy patients

Postoperative time	Activity phase	Activity content and requirements	Person responsible for implementation	Adjustment principles and notes
0-6 hours	Anesthesia recovery period	Supine position without pillow, head turned to one side; guide and assist patient in ankle pump exercises (flexion, extension, circular movements), 20 repetitions per set, one set every 2 hours	Assigned nurse	Applicable to all patients. Assess patient’s consciousness and vital signs
6-24 hours	Bedside active movement period	Gradually raise head of bed to semi-recumbent position (30° → 45° → 60°)	Guided by nurse; performed by patient	For laparoscopic surgery patients or those in good general condition, attempting to sit on the edge of the bed with nurse assistance by the end of this phase can be considered. For elderly, frail, or patients with extensive resection, focus on bedside activities and prolong the adaptation time for semi-recumbent positions
		Continue and intensify ankle pump exercises
		Guide patient in quadriceps isometric contractions and knee flexion/extension exercises
		Encourage deep breathing and effective coughing 5-10 times every hour
24-48 hours	Initial out-of-bed activity period	With nurse or family assistance, slowly sit on the edge of the bed, legs hanging, adapt for 3-5 minutes	Nurse/family assistance	These are standard recommendations. Laparoscopic surgery patients with rapid recovery may appropriately increase activity volume and frequency. For open surgery, extensive resection, or physically weak patients, strictly adhere to the “gradual progression” principle. The timing of first ambulation may be postponed as appropriate; the standing and walking duration should be shortened, based on patient tolerance and absence of discomfort
		If no discomfort, stand with support for 1-2 minutes
		Walk slowly along bedside 5-10 m, 2-3 times daily
> 48 hours	Progressive activity stage	Gradually increase distance, frequency, and duration according to patient tolerance	Supervised by nurse; performed by patient	The goal represents an ideal state and requires individualized assessment. For patients with slow recovery, the goal can be adjusted to walking with assistance or appropriately reducing the distance; the key is persistent daily activity. For patients with comorbid cardiovascular diseases, closely monitor heart rate and blood pressure changes during activity
		Goal: By postoperative day 3, patient can walk independently > 100 m within the ward, 3-4 times daily

Table 3 Comparison of postoperative recovery indicators, mean ± SD

Group	n	Time to first ambulation (hour)	Time to first flatus (hour)	Postoperative hospital stay (days)	Time to drain removal (hour)
Intervention group	100	28.53 ± 6.27	45.66 ± 10.35	5.88 ± 1.57	9.21 ± 2.16
Control group	100	45.88 ± 9.79	62.43 ± 12.89	7.92 ± 2.23	12.50 ± 3.35
t value	-	15.207	10.432	7.894	8.563
P value	-	< 0.001	< 0.001	< 0.001	< 0.001

Table 4 Comparison of postoperative pain levels (Visual Analogue Scale scores, mean ± SD)

Group	n	Post-6 hours	Post-24 hours	Post-3 days	Post-5 days
Intervention group	100	4.52 ± 1.23	3.87 ± 1.05	2.59 ± 0.82	1.64 ± 0.73
Control group	100	4.71 ± 1.36	3.93 ± 1.16	3.27 ± 1.05	2.32 ± 0.96
t value	-	1.052	0.387	5.432	5.876
P value	-	0.294	0.699	< 0.001	< 0.001
Main effect of time	Wald χ2 = 215.36, P < 0.001
Main effect of group	Wald χ2 = 18.74, P < 0.001
Time × group interaction	Wald χ2 = 25.83, P < 0.001

Table 5 Comparison of functional recovery and quality of life between groups

Group	n	ICF-20	6MWT (m)	SF-36
				Pre-1 day	Post-7 days
Intervention group	100	48.59 ± 12.37	285.63 ± 45.88	70.54 ± 11.26	78.96 ± 10.55
Control group	100	62.87 ± 15.62	228.45 ± 52.34	62.18 ± 12.83	70.24 ± 11.82
t	-	7.123	8.324	5.236	6.457
P value	-	< 0.001	< 0.001	< 0.001	< 0.001

ICF-20: International Classification of Functioning, Disability and Health - 20-item Functioning Scale; 6MWT: 6-minute walk test; SF-36: 36-Item Short Form Health Survey.

Table 6 Comparison of nursing satisfaction between groups, n (%)

Group	n	Very satisfied	Satisfied	Dissatisfied	Overall satisfaction
Intervention group	100	65 (65.0)	31 (31.0)	4 (4.0)	96 (96.0)
control group	100	48 (48.0)	34 (34.0)	18 (18.0)	82 (82.0)
χ2 value	-	-	-	-	10.256
P value	-	-	-	-	0.001