Short summary

This study aims to investigate the effect of early initiated and supervised mobilization continued after discharge as management of postoperative pain and recovery following obesity surgery, including patient experiences, pain coping, physical functionality and quality of life. Primary outcome measures 1) Mean abdominal pain at 24 postoperative hours (Numerical Rating Scale). 2) Physical function at 6 months (6-minute walk test).

Rationale

Morbid obesity is an increasing challenge and the number of patients in need of bariatric surgery is increasing. In 2021, approximately 18.5% of the Danish population was severely obese with a body mass index (BMI) above 35 kg/m2. Obesity is associated with diabetes, cardiovascular diseases, musculoskeletal disorders and cancer. The effect of bariatric surgery as a treatment of severe obesity is well-documented, however, it comes with a risk of possible surgical and medical complications including pain. Postoperative pain is common following bariatric surgery and presents as both acute and chronic pain. It is important to acknowledge patient safety and satisfaction as pain can lead to complications such as wound infections, pulmonary- and cardiovascular complications, delirium, a persistent use of opioids and prevent sufficient mobilization and recovery. Various initiatives are needed to achieve better and faster recovery and to contribute to less medication. Early mobilization after surgery entails many benefits, but the effect of mobilization as pain management is sparsely investigated. Patients undergoing bariatric surgery in Denmark have a short length of hospital stay with usual discharge the day after surgery and might therefore benefit from mobilization initiatives continued after discharge in the attempt of mitigating acute and chronic postsurgical pain. Furthermore, continuation of early initiated mobilization might enhance the patients' postoperative recovery and continuity in care following bariatric surgery. Study aims; 1. To investigate the effect of early initiated and continuously supervised mobilization as pain management following bariatric surgery. 2. To investigate patient experiences with early initiated mobilization and postoperative pain, including the influence of mobilization on patients' ability to cope with pain and an identification of facilitating factors and barriers towards early mobilization. 3. To assess the effect of early initiated and supervised mobilization on postoperative recovery, including the general physical activity level, physical function, and quality of life among patients discharged after bariatric surgery.

Description of the cohort

The study population consists of patients undergoing obesity surgery at Esbjerg Hospital, University Hospital of Southern Denmark. Inclusion criteria: age ≥ 18 years and the ability to read and understand the Danish language. Exclusion criteria: Preoperative dependence of walking aids, vision impairment, previous syncopes or epilepsy, admission to the intensive care unit after surgery and acute complications during hospital admission. Patients are excluded at baseline if they have an oxygen saturation below 90% or a systolic blood pressure above 180 mmHg.

Data and biological material

Demographics + level of pain and nausea Questionnaire data (APS-POQ-R-D, PSEQ-DK, PCS, SF-36) Patient journals (Morphine equivalent consumption, readmissions)

Collaborating researchers and departments

Research Unit for Endocrinology, Esbjerg Hospital

• Associate Professor Bibi Gram

Department of Anaesthesiology and Intensive Care, Esbjerg Hospital

• Consultant, PhD Jakob Oxlund

Section of Nursung, Institute of Public Health, Aarhus University

• Professor Pia Dreyer