How does getting up and moving help me recover from surgery?

Question

I've just had a laparoscopic gallbladder removal, done as day surgery. I was released about 3 hours after the surgery started. The sheet of paper they sent me home with stresses the importance of getting up and moving. Resume your normal routine within the limits of your discomfort, they urge me.

About a year ago a relative had a laparoscopic appendix removal and spent a few days in the hospital. Again getting up and moving was considered vital. I accompanied him on many shuffling laps of the floor, iv pole and all.

Why does this help? What is going on physiologically when you walk around (even though it hurts like hell and you break into a cold sweat) rather than rest? Is there some body process being tapped into? What happens to people who don't move around?

Answer 1

This is a broad question, but here are just a few major things to take into consideration after a surgical procedure. Early mobility has been shown for many years to be a major predictor of postoperative outcome, even in something like a hip fracture, where you would think rest was mandatory. The rapidity with which one returns to preoperative levels of independence in activities of daily living decreases postoperative morbidity and optimizes psychological well-being.

Complications of "resting"

Postoperative pulmonary complications, specifically atelectasis and pneumonia, are the leading cause of postoperative morbidity and death. Confinement to bed is a very serious risk factor for atelectasis and pneumonia. After surgery - especially upper abdominal surgery - sufficiently deep breathing needed to prevent some degree of pulmonary compromise is painful. If you're up and moving, you will (voluntarily and involuntarily) be taking more and deeper breaths than you will at rest (characterized by shallower respirations), especially if you're on pain medications.

Venous stasis and thromboembolism commonly occur postoperatively in patients who remain immobile. This is largely preventable with simple ambulation. It hurts to walk around after surgery, to be sure, but it's a lot better than suffering from a largely preventable pulmonary embolism.

All efforts should be made to enforce postoperative movement, which is possible with adequate pain relief.

Loss of strength

Bedrest results in loss of muscle mass and progressively more weakness. While it's not as great a consideration in younger adults as older adults, it is still considerable and, again, is largely preventable. Moving improves strength recovery, appetite, decreases stress, and overall increases feelings of well-being.

Pain Medications

Opioid medications usually given perioperatively can slow your bowels to almost a stand still (it's called ileus) and can result in painful gas buildup and constipation. Moving, and to a lesser extent dietary changes, encourage the bowels to be less sluggish, as does a switch to non-opioid pain medications.

Why "rest"?

Most people think healing is impaired by early movement after surgery. While this is true of some surgeries, it is far from true for all of them. When the risk of resting outweighs the benefits, the goal is to get patients moving.

Atelectasis
Postoperative atelectasis and pneumonia
Management of patients in fast track surgery

Answer 2

I have accepted an answer, but want to add one of my own with some more details I have observed as I go through the process (it's Day 5 today.)

First, this is something you can do to help yourself feel better. Compared to lying in bed, in pain, bored, possibly lonely and scared, and not sure what happens next, just waiting to get better. Giving you something you can do that will improve yourself will, in and of itself, improve you, even if nothing physiological was happening.

Second, it really does work. The vast majority of the pain and effort is simply in getting onto your feet. I noticed quite dramatically that once I had taken 5 or 10 steps I began to feel much better. My pain went down, my strength went up. I am not sure if that was because of increased heart rate and respiration, or the venous return from walking, but there was unmistakably an improvement simply from walking. Several times I would complete the walking distance I had set myself and want to do double or triple that because it was making me feel better.

Third, while you are lying in bed everything is insanely difficult. To reach over and get your drink might involve 10 or more different movements, each of which hurt. Just shifting your weight a little or moving an inch or two to one side you have to fight gravity, drag your body against the bed, etc. Blowing your nose, drinking, changing an uncomfortable position - these things are too hard to do. But when you're vertical, it's far less work to lean a little or turn a little. So you look after your needs better. That means you're less likely to be dehydrated, or to have a coughing fit from stuff you snuffled and swallowed that you should have blown out, or to hurt from lying the wrong way for an hour. This is even more important at home where you don't have beds that can lie you up and down, or tables that swing over the bed to keep things within reach.

Fourth, as with my previous abdominal surgeries I notice that I often need to pee without feeling that sensation of needing to pee at all. Since I'm up and moving anyway, I can stop by the toilet and see if I need to go. Invariably I feel much better, with a huge reduction in pain and improvement in movement, once my bladder is empty. But I hadn't felt an urge that would have pushed me to go through the pain of standing up to deal with it.

Fifth, if this is the norm, especially in the hospital, it makes it easy to spot people who are not recovering at the expected pace. If everyone just lies in bed for 5-6 days waiting to get better, some of them will be majorly ill but you might not notice. If everyone gets up and walks around, the one who can't will stick out like a sore thumb and their infection or whatever will be noticed hours or even days sooner.

While I am still not clear on the exact mechanism that makes this work, I can report that it really does work, on a very small time scale. If you feel awful, getting up and walking for one minute can make you feel better. I still find this counter-intuitive but am pleased that it's standard procedure where I (and my relative) live, because it's clearly helpful.

Answer 3

There may be multiple reasons why your doctor advised you to move around after a surgery.

One common theme that most surgeons follow is to avoid deep venous thrombosis and pulmonary embolism. Post surgery, if the patients are bed ridden for too long, blood tends to accumulate in their calf muscle where there is a secondary blood pump that is active only if those muscles are working. Pooling of blood in the calf muscles increases the risk of formation of clots there, and these clots may be sent to lungs causing pulmonary embolism. Acute pulmonary embolism is a potentially life threatening state, and requires immediate treatment. So if the patient is at risk for developing pulmonary embolism before the surgery, the doctor would want to get in you on your feet as soon as possible. But if the patient is having too much difficulty while walking then there are equipment like calf massagers that does the job. Also, getting the patient on feet early creates a positive attitude and has shown to improve and speed up recovery in patients.

That said, there are conditions where the doctor would want you to do absolute bed rest, such as the conditions where there is increased risk of suture getting ripped due to increased abdominal pain. So if you have too much discomfort, then that is something that you would want to discuss with your doctor.