Published online Aug 27, 2026. doi: 10.4240/wjgs.117895
Revised: March 1, 2026
Accepted: April 7, 2026
Published online: August 27, 2026
Processing time: 201 Days and 19 Hours
Intestinal tuberculosis is the most common form of abdominal tuberculosis, and surgical intervention is required when complications arise or conservative treat
To evaluate the clinical effectiveness of an early mobilization protocol based on ERAS principles on postoperative gastrointestinal function recovery in patients undergoing intestinal tuberculosis surgery.
Clinical data from 102 patients who underwent intestinal tuberculosis surgery at our hospital between July 2018 and February 2025 were retrospectively analyzed. Patients were divided into two groups based on postoperative rehabilitation pro
Baseline characteristics were comparable between the two groups (P > 0.05). Compared with the control group, the intervention group demonstrated significantly shorter time to first flatus, time to first defecation, time to bowel sound recovery, and time to first ambulation (all P < 0.01). The modified Barthel Index and Karnofsky Performance Status scores on postoperative days 3 and 7 were higher in the intervention group than in the control group (all P < 0.05). Visual Analog Scale pain scores at all time points were lower in the intervention group compared with the control group, with reduced analgesic medication consumption (all P < 0.05). The overall complication rate showed no statistical difference between the two groups (P > 0.05).
The early mobilization protocol based on ERAS principles can safely and effectively promote postoperative gas
Core Tip: This study provides the first evidence supporting the safety and effectiveness of enhanced recovery after surgery-based early mobilization in intestinal tuberculosis surgery. Despite the unique challenges of chronic inflammation, malnutrition, and anastomotic healing concerns in this population, the structured early mobilization protocol significantly accelerated gastrointestinal function recovery, improved functional status, and reduced pain without increasing complications, suggesting that enhanced recovery after surgery principles can be safely extended to infectious gastrointestinal surgical pathologies.
- Citation: Li XN, Zhang CX, He Q, Xue JM. Effect of enhanced recovery after surgery-based early mobilization on gastrointestinal recovery after intestinal tuberculosis surgery. World J Gastrointest Surg 2026; 18(8): 117895
- URL: https://www.wjgnet.com/1948-9366/full/v18/i8/117895.htm
- DOI: https://dx.doi.org/10.4240/wjgs.117895
Abdominal tuberculosis represents a chronic inflammatory disease caused by Mycobacterium tuberculosis infection of the peritoneum and intra-abdominal organs, constituting an important type of extrapulmonary tuberculosis[1]. Intestinal tuberculosis is the most common manifestation of abdominal tuberculosis, accounting for approximately 70%-90% of cases, predominantly affecting the gastrointestinal regions including the ileocecal area and terminal ileum[1]. With the rising global incidence of tuberculosis and the increasing population of immunocompromised individuals, the incidence of intestinal tuberculosis has demonstrated an upward trend, emerging as a significant clinical challenge. The disease has an insidious onset with diverse clinical manifestations, frequently accompanied by non-specific symptoms such as abdominal pain, distension, fever, and weight loss, leading to frequent misdiagnosis and delayed diagnosis[2]. When conservative treatment proves ineffective or complications such as intestinal obstruction, intestinal perforation, or gastrointestinal bleeding occur, gastrointestinal surgical intervention becomes a necessary therapeutic approach. However, patients undergoing intestinal tuberculosis surgery frequently face issues including slow gastrointestinal function recovery, high complication rates, and prolonged hospital stays, which not only affect the rehabilitation process but also increase medical costs and patient burden.
Enhanced recovery after surgery (ERAS) concept, introduced in the 1990s, has gained widespread application and development in the surgical field[3]. ERAS emphasizes perioperative optimization management guided by evidence-based medicine, including comprehensive intervention measures in the preoperative, intraoperative, and postoperative periods, aiming to reduce surgical stress response, promote rapid patient recovery, decrease complication rates, and shorten hospital stays. Early mobilization, as a core component of the ERAS concept, has been demonstrated to effectively promote gastrointestinal function recovery, reduce thromboembolic risk, improve pulmonary function, and enhance overall patient rehabilitation[4].
Traditional postoperative management models typically require patients to remain in bed for extended periods after surgery, waiting for spontaneous intestinal function recovery before gradually mobilizing. This “wait-and-see” man
This study retrospectively analyzed patients who underwent intestinal tuberculosis surgery at our hospital between July 2018 and February 2025, evaluating the impact of an early mobilization protocol based on ERAS principles on post
Inclusion criteria: (1) Age between 18 and 75 years; (2) Diagnosis of intestinal tuberculosis confirmed by pathological or bacteriological examination; (3) Underwent laparoscopic or open intestinal resection, intestinal anastomosis, or other gastrointestinal surgical procedures; (4) Preoperative American Society of Anesthesiologists (ASA) classification grade I-III; and (5) Complete clinical data with comprehensive follow-up records.
Exclusion criteria: (1) Severe dysfunction of vital organs including heart, lung, or kidney; (2) Preoperative intestinal obstruction; (3) Extensive intestinal adhesions discovered during surgery requiring extensive adhesiolysis; (4) Re
All surgical procedures were performed by attending physicians or associate chief physicians with more than 10 years of gastrointestinal surgical experience. Surgical approach was selected based on patient condition, location of intestinal lesions, degree of adhesions, and patient preference. Laparoscopic surgery employed a four-port or five-port technique with carbon dioxide pneumoperitoneum pressure maintained at 12-14 mmHg, with adequate mobilization of affected intestinal segments, resection of tuberculous intestinal lesions and surrounding involved intestinal segments, and intestinal resection with anastomosis or adhesiolysis performed according to the extent of lesions. Open surgery utilized a midline abdominal incision with thorough exploration of the abdominal cavity, treatment of intestinal tuberculosis lesions, and intestinal resection with reconstruction or abdominal drainage as necessary. All surgical procedures followed aseptic technique principles, avoiding rupture and dissemination of tuberculous lesions during surgery, with routine placement of abdominal drainage tubes postoperatively. Surgical approach selection was primarily based on comprehensive assessment of preoperative imaging evaluation, patient general condition, and surgeon experience.
Patients were divided into two groups according to different postoperative rehabilitation protocols: (1) Control group (n = 51): Received traditional postoperative rehabilitation protocol; and (2) Intervention group (n = 51): Received early mobilization protocol based on ERAS principles. Specifically, group allocation was determined by the temporal adoption of the standardized ERAS-based early mobilization protocol at our institution. Patients who underwent surgery prior to the formal implementation of this protocol received the traditional postoperative rehabilitation protocol (control group), whereas patients who underwent surgery after the protocol was adopted received the early mobilization protocol (intervention group). This temporal division is a commonly employed approach in retrospective studies evaluating the impact of newly implemented clinical protocols.
It should be noted that other perioperative management components - including anesthetic technique, fluid management, and perioperative nutritional support - were standardized across both groups according to institutional protocols. The primary distinguishing variable between the two groups was the postoperative mobilization protocol. However, certain ERAS-specific preoperative elements were incorporated into the intervention group, such as abbreviated preoperative fasting and preoperative patient education regarding early mobilization, as detailed below.
Control group (traditional postoperative rehabilitation protocol): Patients in the control group received conventional postoperative management: Absolute bed rest with nil per os on the day of surgery; passive bed exercises including ankle pump exercises and deep breathing exercises beginning on postoperative day 1, lasting 10-15 minutes per session, 3-4 times daily; sitting at bedside beginning on postoperative day 2 according to patient tolerance, for 15-30 minutes; assisted standing and short-distance ambulation with healthcare personnel support beginning on postoperative days 3-4; liquid diet initiated after bowel sound recovery, gradually progressing to semi-liquid and regular diet. Pain management employed conventional analgesic medications administered as needed.
Intervention group (early mobilization protocol based on ERAS principles): Patients in the intervention group received a comprehensive early mobilization protocol designed based on ERAS principles, with specific measures as follows: (1) Preoperative preparation phase: Health education initiated immediately upon hospital admission, with detailed introduction of ERAS principles and the importance of early mobilization, eliminating patient fears regarding early ambulation; routine preoperative fasting not mandatory, with cessation of solid food intake 6 hours before surgery and clear liquid intake 2 hours before surgery; (2) Immediate postoperative period to 6 hours: Passive bed exercises initiated immediately upon patient awakening, including ankle pump exercises, lower limb flexion-extension movements, and deep breathing exercises, lasting 10-15 minutes per session, repeated every 2 hours. Multimodal pain management implemented simultaneously, including patient-controlled analgesia (PCA) pump combined with non-steroidal anti-inflammatory drugs, maintaining VAS pain score ≤ 3; (3) 6-24 hours postoperatively: With stable vital signs and absence of active bleeding signs, patients were assisted to sit at bedside, with initial duration of 15-20 minutes, gradually extending to 30-45 minutes according to patient tolerance, 2-3 times daily. Active bed exercises continued, with addition of upper limb activities and trunk rotation exercises; (4) 24-48 hours postoperatively: Assisted standing initiated, with initial standing time of 5-10 minutes, gradually progressing to short-distance ambulation (10-20 steps within the ward). Vital signs were closely monitored during activities, with immediate cessation of activity and return to bed rest if symptoms such as dizziness, nausea, or blood pressure drop occurred. Small amounts of warm water intake could be initiated at this stage; (5) 48-72 hours postoperatively: Based on patient tolerance of short-distance ambulation, activity intensity and duration were gradually increased. Ambulation distance increased to one round trip in the ward corridor (approximately 50-100 m), 2-3 times daily, lasting 15-20 minutes per session. Liquid diet initiated according to bowel sound recovery status; (6) After 72 hours postoperatively: Activity level continued to increase, with ambulation distance reaching 200-300 m, 3-4 times daily, while adding functional activities such as stair climbing (performed with healthcare personnel accompaniment). Diet gradually progressed from liquid to semi-liquid and regular diet; (7) Activity safety monitoring: All early mobilization activities were conducted under the guidance and supervision of professional healthcare personnel trained in ERAS. Pre-activity assessment protocol established, including vital sign monitoring, pain assessment, and incision site examination. Activity cessation criteria defined: Systolic blood pressure < 90 mmHg or > 180 mmHg, heart rate < 60 beats per minute (bpm) or > 120 bpm, oxygen saturation < 95%, VAS pain score > 5, or occurrence of severe discomfort symptoms; and (8) Individualized adjustment: Individualized adjustments made according to patient age, underlying diseases, surgical approach (laparoscopic vs open), and postoperative recovery status. For elderly patients (> 65 years) or those with underlying diseases, activity progression was appropriately delayed and activity intensity reduced. Laparoscopic surgery patients could advance activity timing appropriately, while open surgery patients required more cautious assessment of incision healing status.
General data: Basic demographic characteristics and clinical data of both groups were recorded, including: Age, gender, education level, marital status, body mass index, comorbidities (hypertension, diabetes, hyperlipidemia, others), ASA classification, preoperative hemoglobin level, and serum albumin level.
Gastrointestinal function recovery indicators: (1) Time to first flatus: Time interval from surgery to first anal gas passage (hours); (2) Time to first defecation: Time interval from surgery to first spontaneous bowel movement (hours); (3) Time to bowel sound recovery: Time interval from surgery to recovery of normal bowel sounds (≥ 3 times per minute) (hours); (4) Time to first liquid diet intake (hours); (5) Time to first semi-liquid diet intake (hours); (6) Time to resumption of regular diet (days); (7) Duration of nasogastric tube placement (hours); and (8) Incidence of postoperative gastric retention.
Postoperative mobilization-related indicators: (1) Time to first ambulation (hours); (2) Time to first independent walking (hours); (3) Mobilization tolerance at 24 hours, 48 hours, and 72 hours postoperatively; (4) Magnitude of blood pressure and heart rate changes after first ambulation; and (5) Compliance rate for daily walking distance (walking ≥ 100 m on postoperative day 3). Good activity tolerance was defined as the ability to complete the prescribed mobilization activity for the corresponding postoperative time point (i.e., sitting at bedside for ≥ 15 minutes at 24 hours, standing and walking ≥ 10 steps at 48 hours, and corridor ambulation of ≥ 50 m at 72 hours) without experiencing any of the following adverse events: Systolic blood pressure drop > 20 mmHg or increase > 30 mmHg from baseline, heart rate increase > 30 beats per minute from baseline, oxygen saturation < 95%, VAS pain score > 5, or onset of dizziness, nausea, or severe fatigue requiring activity cessation.
Quality of life and functional status assessment: (1) Modified Barthel Index: Assessed patient activities of daily living, including 10 items such as feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, bed-to-chair transfer, walking on level surfaces, and stair climbing, with a total score of 100 points, assessed preoperatively, on postoperative day 3 and day 7; and (2) KPS scale: Assessed overall patient functional status, with scoring range of 0-100 points, assessed preoperatively, on postoperative day 3, day 7, and at discharge.
Pain management-related indicators: (1) Postoperative pain intensity: Assessed using VAS, evaluated at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively; (2) Analgesic medication consumption (within 72 hours postoperatively); (3) PCA pump total attempts and effective attempts; and (4) Postoperative sleep quality: Assessed using Pittsburgh Sleep Quality Index (PSQI) scale, which includes 7 dimensions: Sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction, with a total score of 21 points where higher scores indicate poorer sleep quality, assessed on postoperative day 1, day 3, and day 7.
Complication occurrence: Postoperative complications primarily included intestinal obstruction, abdominal distension, nausea and vomiting, incision infection, pulmonary infection, deep vein thrombosis, and urinary tract infection.
Data analysis was performed using SPSS version 26.0 statistical software. All continuous variables were first subjected to normality testing (Shapiro-Wilk test). Normally distributed quantitative data were presented as mean ± SD, with independent samples t-test used for between-group comparisons; non-normally distributed quantitative data were presented as median and interquartile range [M (Q1, Q3)], with Mann-Whitney U test used for between-group com
This study was approved by the hospital ethics committee, and all data collection and use complied with medical research ethical requirements, with strict protection of patient privacy.
This study enrolled a total of 102 patients undergoing intestinal tuberculosis surgery, with 51 cases in the control group and 51 cases in the intervention group. No statistically significant differences were observed between the two groups in baseline characteristics including age, gender, education level, marital status, body mass index, comorbidities, ASA classification, preoperative hemoglobin level, and serum albumin level (P > 0.05), indicating comparability (Table 1).
| Item | Control group (n = 51) | Intervention group (n = 51) | Statistic | P value |
| Age (years) | 45.2 ± 13.7 | 43.8 ± 14.2 | t = 0.524 | 0.602 |
| Gender | χ2 = 0.157 | 0.692 | ||
| Male | 28 (54.9) | 26 (51.0) | ||
| Female | 23 (45.1) | 25 (49.0) | ||
| Education level | χ2 = 1.247 | 0.742 | ||
| Junior high school and below | 18 (35.3) | 15 (29.4) | ||
| High school/vocational | 21 (41.2) | 24 (47.1) | ||
| College and above | 12 (23.5) | 12 (23.5) | ||
| Marital status | χ2 = 0.392 | 0.531 | ||
| Married | 39 (76.5) | 37 (72.5) | ||
| Unmarried/other | 12 (23.5) | 14 (27.5) | ||
| BMI (kg/m2) | 22.4 ± 3.1 | 22.8 ± 3.4 | t = 0.635 | 0.527 |
| Comorbidities | ||||
| Hypertension | 13 (25.5) | 15 (29.4) | χ2 = 0.201 | 0.654 |
| Diabetes | 8 (15.7) | 6 (11.8) | χ2 = 0.349 | 0.555 |
| Hyperlipidemia | 11 (21.6) | 9 (17.6) | χ2 = 0.249 | 0.618 |
| ASA classification | χ2 = 0.471 | 0.790 | ||
| Grade I | 23 (45.1) | 25 (49.0) | ||
| Grade II | 21 (41.2) | 19 (37.3) | ||
| Grade III | 7 (13.7) | 7 (13.7) | ||
| Preoperative hemoglobin (g/L) | 118.6 ± 15.3 | 121.2 ± 16.8 | t = 0.825 | 0.412 |
| Preoperative serum albumin (g/L) | 36.8 ± 4.2 | 37.5 ± 4.6 | t = 0.822 | 0.413 |
Patients in the intervention group demonstrated significantly superior performance across all gastrointestinal function recovery indicators compared with the control group. The intervention group showed significantly shorter time to first flatus, time to first defecation, time to bowel sound recovery, time to first liquid diet intake, time to first semi-liquid diet intake, time to resumption of regular diet, and duration of nasogastric tube placement compared with the control group, with statistically significant differences (all P < 0.01). No statistically significant difference was observed in the incidence of postoperative gastric retention between the two groups (P > 0.05) (Table 2).
| Item | Control group (n = 51) | Intervention group (n = 51) | Statistic | P value |
| Time to first flatus (hours) | 68.4 ± 18.2 | 55.8 ± 15.3 | t = 3.805 | < 0.001 |
| Time to first bowel movement (hours) | 89.7 ± 22.5 | 76.4 ± 19.1 | t = 3.224 | 0.002 |
| Bowel sound recovery time (hours) | 45.6 ± 12.8 | 38.5 ± 11.2 | t = 3.014 | 0.003 |
| Time to first liquid diet intake (hours) | 76.8 ± 19.4 | 64.7 ± 16.8 | t = 3.439 | 0.001 |
| Time to first semi-liquid diet intake (hours) | 118.3 ± 28.6 | 104.2 ± 24.7 | t = 2.712 | 0.008 |
| Time to normal diet recovery (days) | 6.8 ± 1.9 | 5.9 ± 1.6 | t = 2.641 | 0.010 |
| Nasogastric tube retention time (hours) | 58.7 ± 16.3 | 48.3 ± 14.1 | t = 3.502 | 0.001 |
| Postoperative gastric retention incidence | 12 (23.5) | 6 (11.8) | χ2 = 2.574 | 0.109 |
Patients in the intervention group demonstrated significantly superior performance in postoperative mobilization-related indicators compared with the control group. The intervention group showed significantly shorter time to first ambulation and time to first independent walking compared with the control group (all P < 0.001). Regarding mobilization tolerance at 24 hours and 48 hours postoperatively, the intervention group demonstrated superior performance compared with the control group (all P < 0.05), while the difference in mobilization tolerance at 72 hours postoperatively was not statistically significant (P > 0.05). The magnitude of blood pressure and heart rate changes after first ambulation was smaller in the intervention group compared with the control group, and the compliance rate for daily walking distance was significantly higher in the intervention group compared with the control group (all P < 0.05) (Table 3).
| Item | Control group (n = 51) | Intervention group (n = 51) | Statistic | P value |
| Time to first ambulation (hours) | 54.6 ± 12.4 | 26.8 ± 8.7 | t = 13.052 | < 0.001 |
| Time to first independent walking (hours) | 78.3 ± 18.9 | 58.4 ± 15.6 | t = 5.857 | < 0.001 |
| Good activity tolerance at 24 hours postop | 28 (54.9) | 38 (74.5) | χ2 = 4.195 | 0.041 |
| Good activity tolerance at 48 hours postop | 35 (68.6) | 44 (86.3) | χ2 = 4.558 | 0.033 |
| Good activity tolerance at 72 hours postop | 42 (82.4) | 47 (92.2) | χ2 = 2.174 | 0.140 |
| SBP change after first ambulation (mmHg) | 19 ± 8 | 14 ± 7 | t = 2.934 | 0.004 |
| HR change after first ambulation (bpm) | 16 ± 7 | 12 ± 6 | t = 2.707 | 0.008 |
| Walking ≥ 100 m on POD 3 | 31 (60.8) | 42 (82.4) | χ2 = 5.827 | 0.016 |
No statistically significant differences were observed in preoperative modified Barthel Index and KPS scores between the two groups (P > 0.05). On postoperative days 3 and 7, patients in the intervention group demonstrated higher modified Barthel Index and KPS scores compared with the control group, with statistically significant differences (all P < 0.01). KPS scores at discharge were also significantly higher in the intervention group compared with the control group (P < 0.001) (Table 4, Figure 1).
| Item | Control group (n = 51) | Intervention group (n = 51) | t value | P value |
| Modified Barthel Index | ||||
| Preoperative | 87.2 ± 9.4 | 88.1 ± 8.9 | 0.516 | 0.607 |
| Postoperative day 3 | 78.5 ± 11.2 | 83.8 ± 10.6 | 2.542 | 0.012 |
| Postoperative day 7 | 84.3 ± 9.8 | 88.6 ± 8.7 | 2.394 | 0.018 |
| KPS score | ||||
| Preoperative | 86.5 ± 7.8 | 87.2 ± 7.3 | 0.483 | 0.630 |
| Postoperative day 3 | 79.8 ± 8.6 | 84.2 ± 7.9 | 2.782 | 0.006 |
| Postoperative day 7 | 84.7 ± 7.2 | 88.4 ± 6.8 | 2.750 | 0.007 |
| At discharge | 87.8 ± 6.4 | 91.5 ± 5.8 | 3.154 | 0.002 |
Patients in the intervention group demonstrated lower VAS pain scores at all time points compared with the control group, with statistically significant differences (all P < 0.05). Analgesic medication consumption was lower in the intervention group compared with the control group (P < 0.001), and both total attempts and effective attempts of PCA pump were lower in the intervention group compared with the control group (all P < 0.01). Sleep quality assessment at various postoperative time points showed that PSQI scores were lower in the intervention group compared with the control group, indicating better sleep quality (all P < 0.05) (Table 5, Figure 2).
| Item | Control group (n = 51) | Intervention group (n = 51) | Statistic | P value |
| VAS pain score (points) | ||||
| 6 hours postoperatively | 5.2 ± 1.4 | 4.6 ± 1.3 | t = 2.315 | 0.023 |
| 12 hours postoperatively | 4.6 ± 1.3 | 4.1 ± 1.2 | t = 2.064 | 0.042 |
| 24 hours postoperatively | 4.1 ± 1.2 | 3.6 ± 1.1 | t = 2.255 | 0.026 |
| 48 hours postoperatively | 3.4 ± 1.1 | 2.9 ± 1.0 | t = 2.465 | 0.015 |
| 72 hours postoperatively | 2.8 ± 1.0 | 2.4 ± 0.9 | t = 2.184 | 0.032 |
| Analgesic medication usage (mg) | 156.7 ± 38.4 | 127.8 ± 32.6 | t = 4.185 | < 0.001 |
| Total PCA presses (times) | 48.6 ± 12.7 | 39.4 ± 11.2 | t = 3.936 | < 0.001 |
| Effective PCA presses (times) | 32.4 ± 8.9 | 26.8 ± 7.6 | t = 3.513 | 0.001 |
| PSQI score (points) | ||||
| Postoperative day 1 | 11.8 ± 2.6 | 10.2 ± 2.3 | t = 3.353 | 0.001 |
| Postoperative day 3 | 9.4 ± 2.3 | 8.1 ± 2.0 | t = 3.083 | 0.003 |
| Postoperative day 7 | 7.2 ± 1.8 | 6.2 ± 1.6 | t = 3.025 | 0.003 |
The overall complication rate showed no statistically significant difference between the two groups (15.7% vs 11.8%, P = 0.563). In the control group, 3 cases (5.9%) of intestinal obstruction, 4 cases (7.8%) of abdominal distension, and 1 case (2.0%) of nausea and vomiting occurred, totaling 8 patients with complications; in the intervention group, 1 case (2.0%) of intestinal obstruction, 3 cases (5.9%) of abdominal distension, and 2 cases (3.9%) of nausea and vomiting occurred, totaling 6 patients with complications. The incidence of each type of complication showed no statistically significant difference between groups (P > 0.05). Neither group experienced serious complications such as incision infection, pulmonary infection, deep vein thrombosis, or urinary tract infection (Table 6).
| Complication type | Control group (n = 51) | Intervention group (n = 51) | P value1 |
| Intestinal obstruction | 3 (5.9) | 1 (2.0) | 0.617 |
| Abdominal distension | 4 (7.8) | 3 (5.9) | 1.000 |
| Nausea and vomiting | 1 (2.0) | 2 (3.9) | 1.000 |
| Total incidence | 8 (15.7) | 6 (11.8) | 0.563 |
Through retrospective analysis of clinical data from 102 patients undergoing intestinal tuberculosis surgery, this study systematically evaluated the clinical effectiveness of an early mobilization protocol based on ERAS principles on postoperative gastrointestinal function recovery. The results demonstrate that compared with traditional postoperative rehabilitation protocols, the early mobilization protocol exhibited significant advantages in promoting gastrointestinal function recovery, improving mobilization tolerance, enhancing quality of life and functional status, and optimizing pain management, without increasing postoperative complication rates, confirming the safety and effectiveness of this protocol in patients undergoing intestinal tuberculosis surgery.
In this study, patients in the intervention group demonstrated significantly shorter time to first flatus, time to first defecation, and time to bowel sound recovery compared with the control group, consistent with previous research findings on the application of ERAS principles in gastrointestinal surgery[7]. The mechanisms by which early mobi
Notably, as a chronic inflammatory disease affecting the gastrointestinal tract, intestinal tuberculosis patients often present with varying degrees of malnutrition and immune dysfunction preoperatively, which may influence the speed of postoperative gastrointestinal function recovery[11]. The results of this study indicate that even in this special disease context, the early mobilization protocol can effectively promote gastrointestinal function recovery, further confirming the universality and effectiveness of the ERAS concept. In this study, patients in the intervention group demonstrated approximately 0.9 days shorter time to resumption of regular diet compared with the control group, which not only facilitates improvement of patient nutritional status but also establishes a favorable foundation for subsequent anti-tuberculosis treatment[12].
Safety represents the primary consideration in implementing early mobilization protocols. This study established comprehensive pre-activity assessment protocols and activity cessation criteria, ensuring safe implementation of early mobilization. The results demonstrate that patients in the intervention group exhibited significantly superior mobilization tolerance at 24 hours and 48 hours postoperatively compared with the control group, with smaller magnitudes of blood pressure and heart rate changes after first ambulation, indicating favorable safety of the early mobilization protocol. These findings align with results reported in international research[13].
Due to the characteristics of intestinal lesions, patients undergoing intestinal tuberculosis surgery may experience issues such as intestinal adhesions and slower intestinal anastomotic healing postoperatively, presenting higher safety requirements for early mobilization[14]. Through individualized adjustment of mobilization protocols in this study, with activity plans formulated according to patient age, underlying diseases, surgical approach, and other factors, activity-related risks were effectively reduced. The study showed no significant difference in overall postoperative complication rates between the two groups (15.7% vs 11.8%, P = 0.563), with no serious complications occurring in either group, further confirming the safety of the early mobilization protocol in patients undergoing intestinal tuberculosis surgery. Although the overall complication rate did not reach statistical significance, the numerical trends remain clinically noteworthy, particularly the lower incidence of intestinal obstruction in the intervention group (2.0% vs 5.9%). A post hoc power analysis revealed that with the current sample size of 51 patients per group, this study had approximately 18% power to detect the observed difference in overall complication rates at a significance level of 0.05, which is substantially below the conventionally accepted threshold of 80%. To detect a clinically meaningful difference in complication rates of the magnitude observed, an estimated sample size of approximately 400-500 patients per group would be required. There
This study employed the modified Barthel Index and KPS scoring systems to evaluate patient quality of life and functional status, with results showing that patients in the intervention group demonstrated significantly higher scores at all postoperative time points compared with the control group. This finding is consistent with multiple studies on ERAS application in other gastrointestinal surgical procedures[15]. Early mobilization not only prevents muscle atrophy and joint stiffness resulting from prolonged bed rest but also improves patient psychological status and enhances rehabilitation confidence[16].
Intestinal tuberculosis patients often have prolonged disease duration with preoperative quality of life already affected to some extent. The results of this study indicate that through implementation of the early mobilization protocol, patient functional status recovery time can be effectively shortened and overall rehabilitation level improved. This holds significant importance for patients requiring long-term anti-tuberculosis treatment, as favorable functional status contributes to improved patient treatment compliance and quality of life[17].
Pain represents one of the primary barriers to early mobilization after surgery. This study implemented multimodal pain management strategies, including PCA pumps combined with non-steroidal anti-inflammatory drugs, effectively controlling postoperative pain. Results showed that patients in the intervention group demonstrated lower VAS pain scores at all time points compared with the control group, with significantly reduced analgesic medication consumption. This finding is consistent with related research reports, indicating that effective pain management serves as an important guarantee for successful implementation of early mobilization protocols[18].
Notably, favorable pain control not only facilitates implementation of early mobilization but also improves patient sleep quality. In this study, patients in the intervention group demonstrated lower PSQI scores at all time points com
Although this study did not directly evaluate hospital stay duration and medical expenses, from the shortened gas
As a retrospective study, this research has certain limitations. First, the retrospective nature of the study design may introduce selection bias and information bias[21]. In addition, the temporal grouping method, whereby patients treated before protocol implementation served as controls, may introduce temporal confounding, as concurrent improvements in surgical techniques, nursing practices, or other perioperative factors over time could have partially contributed to the observed differences. Second, the sample size is relatively small, and as a single-center study, the generalizability of results requires further verification. The modest sample size of 102 patients limits the statistical power for subgroup analyses, such as stratification by surgical approach (laparoscopic vs open) or severity of tuberculous involvement, which would be valuable in identifying patient subpopulations that may benefit most from the early mobilization protocol. Additionally, this study was unable to evaluate long-term follow-up outcomes, such as changes in functional status and quality of life at 6 months and 1 year postoperatively[22].
Furthermore, the degree of intestinal lesions and extent of adhesions vary considerably among intestinal tuberculosis patients, and these factors may influence the effectiveness of early mobilization protocols, but this study was unable to conduct detailed subgroup analysis[23]. Future research should consider conducting multicenter, large-sample pro
The results of this study indicate that the application of early mobilization protocols based on ERAS principles in patients undergoing intestinal tuberculosis surgery is safe and effective, providing novel approaches and methods for perioperative management of this special population of gastrointestinal disease patients. With deepening understanding of ERAS principles and continuous refinement of related techniques, early mobilization protocols are expected to achieve broader application in patients undergoing intestinal tuberculosis surgery[24].
From a clinical practice perspective, successful implementation of early mobilization protocols requires multidisciplinary team collaboration, including joint participation of gastrointestinal surgeons, anesthesiologists, nursing personnel, and rehabilitation therapists[25]. Simultaneously, establishment of standardized operational procedures and quality control systems is necessary to ensure protocol implementation standardization and consistency. Medical institutions should emphasize promotion of ERAS principles and training of relevant personnel, creating favorable conditions for widespread application of early mobilization protocols[26].
Based on the results of this study, future research may proceed in several directions: First, conducting multicenter, large-sample prospective randomized controlled trials to further verify the application effectiveness of early mobilization protocols in patients undergoing intestinal tuberculosis surgery[27]. Second, exploring individualized early mobilization protocol development strategies, optimizing activity plans according to specific patient conditions, surgical approaches, baseline status, and other factors. Additionally, investigating synergistic effects between early mobilization protocols and other ERAS components, such as overall effects of comprehensive measures including preoperative optimization, intraoperative protection, and postoperative rapid rehabilitation[28].
In conclusion, this study confirms the positive role of early mobilization protocols based on ERAS principles in post
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