Effects of an Early Postoperative Ambulation Program on Bowel Function and Recovery Among Patients After Open Appendectomy

Abstract

Introduction Acute appendicitis is the most common condition among patients presenting with acute abdominal pain. Open appendectomy under general anesthesia remains the standard and widely practiced treatment. However, the most frequent postoperative complication is postoperative ileus, which arises from multiple causes, including direct manipulation of the intestines during surgery, the inhibitory effects of general anesthetics or opioid analgesics on bowel movement, and delayed mobilization due to postoperative fatigue. These factors result in impaired peristalsis, leading to abdominal distension, pain, nausea, vomiting, inability to belch, and absence of bowel sounds. Management typically requires prokinetic agents or nasogastric decompression. Currently, recovery programs designed to reduce postoperative ileus following open appendectomy are limited and lack clear implementation in clinical practice. Their effectiveness depends on several factors, such as the type of surgical incision, the timing of ambulation, and the risk of postoperative complications. Previous studies have demonstrated that early mobilization after surgery is the most effective strategy to facilitate the return of bowel function. Therefore, the researchers developed an early postoperative ambulation program to systematically promote prompt mobilization, stimulate intestinal activity, and enhance overall postoperative recovery.

Objective The objective of this study was to examine the effects of an early postoperative ambulation program on bowel function and overall recovery among patients undergoing open appendectomy.

Design This study employed a quasi-experimental design with a two-group repeated measures design. The investigation was guided by the core pathophysiological concept of postoperative ileus (POI) as the primary framework for examining postoperative outcomes.

Methodology The study participants comprised 62 patients, both male and female, who underwent open appendectomy at a hospital in Ubon Ratchathani Province. Participants were purposively selected based on the following inclusion criteria: 1) age 18 years or older; for those aged 60 years or above, normal cognitive function was required as assessed by a cognitive impairment screening tool; 2) undergoing open appendectomy for either uncomplicated appendicitis or perforated appendix, with a minimum preoperative hospital stay of six hours; and 3) administration of general anesthesia during surgery. Exclusion criteria were: 1) acute appendicitis requiring true emergency surgery without prior inpatient preparation; 2) concurrent abdominal surgery for other conditions performed in the same operative session; 3) pre- or postoperative musculoskeletal disorders such as fractures, dislocations, muscle weakness, herniated discs, Parkinson’s disease, or physical limitations including hemiplegia, paraplegia, or limb amputation; 4) psychiatric diagnoses including depression, schizophrenia, bipolar disorder, panic disorder, or alcohol withdrawal; and 5) pregnancy. Participants were allocated into a control group (n = 31) and an experimental group (n = 30). The program began 6 hours before surgery and emphasized postoperative mobilization, including in-bed, bedside, and out-of-bed activities. Data were collected using demographic form, illness and treatment records, a bowel function recovery assessment, and a postoperative recovery quality assessment. Data collection in the control group was completed first. Statistical analyses included Chi-square test, Fisher’s exact test, Independent t-test, Mann–Whitney U test, and Two-Way Repeated Measures ANOVA at postoperative intervals of 12, 24, and 36 hours.

Results The majority of participants were in middle adulthood (aged 45–59 years), accounting for approximately 30%. A statistically significant difference was observed between the two groups in the incidence of postoperative ileus (POI) (p = .005), with the experimental group demonstrating a lower incidence than the control group (10.00% vs. 41.94%, respectively). This finding was consistent with the mean bowel function scores, which were higher in the experimental group across all time points. The difference between groups was statistically significant (F = 4.034, p = .049), and bowel function increased progressively at 12, 24, and 36 hours postoperatively (F = 77.659, p < .001). Pairwise comparisons revealed significant differences at all time intervals (p < .001). However, no significant interaction effect was found between the intervention program and time (F = 2.801, p = .065). In terms of overall postoperative recovery scores, no statistically significant difference was found between the experimental and control groups (F = 0.028, p = .869). Nevertheless, both groups exhibited continuous improvement over time at 12, 24, and 36 hours postoperatively (F = 111.459, p < .001), with pairwise comparisons showing significant differences at all intervals (p < .001). Similar to bowel function outcomes, no significant interaction effect was observed between the intervention program and time (F = 0.159, p = .853).

Recommendation Nurses should integrate this program into the care of patients undergoing open appendectomy by providing preoperative guidance and systematically implementing early postoperative mobilization activities. These activities should be conducted progressively, beginning in bed, continuing at the bedside, and extending to out-of-bed exercises in a consistent and structured manner to promote bowel function and enhance postoperative physical recovery. For future research, it is recommended that the program be further developed into a mobile application with an accompanying online manual, thereby increasing patient accessibility and convenience in performing recovery activities.