The Effect of Early Mobilization as Part of Enhanced Recovery After Surgery on Postoperative Outcomes After Emergency Abdominal Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Early mobilization is considered a key strategy for enhancing recovery after elective surgery, yet its effect after emergency surgery remains unclear. Through this systematic review, we aim to isolate mobilization as a postoperative variable in an emergency setting to clarify its role in recovery and support evidence-based clinical guidelines.

METHODS: A systematic search was conducted in MEDLINE, Embase, and Cochrane on November 20, 2024, to identify studies on mobilization after emergency abdominal surgery. The review was registered in PROSPERO (CRD42024556789). Eligible studies reported short-term outcomes of postoperative mobilization, including postoperative complications, mortality, length of stay, and postoperative convalescence in adult patients. Studies were excluded if they focused exclusively on elective surgery. Studies were screened independently by two reviewers. Risk of bias was assessed using the ROB-2 for randomized controlled trials (RCTs) and ROBINS-I for observational studies. Meta-analyses used random-effects model, with results expressed as risk ratios, odds ratios or mean differences. Certainty of evidence was evaluated with GRADE.

RESULTS: The search yielded 3064 records, of which 19 studies met inclusion criteria (seven RCTs and 12 observational studies), involving 3222 patients. Interventions mainly included early mobilization as part of ERAS protocols. Overall risk of bias was high and certainty of evidence very low. Observational studies showed reduced major complication (OR 0.75 (95% CI [0.61; 0.93])), whereas RCTs found no significant difference. Early mobilization reduced length of stay (RCTs: MD -1.95 days (95% CI [-3.16; -0.75])); Observational: MD -2.84 days (95% CI [-3.84; -1.83]) and time to first diet (RCTs: MD 0.95 days (95% CI [-1.61 to -0.29])); Observational: MD -2.30 days (95% CI [-2.36 to -2.24]). Return of bowel function was earlier (RCTs: MD -0.87 days (95% CI [-1.59; -0.16])); Observational: -0.91 days (95% CI [-1.71; -0.10]). RCTs also reported less postoperative nausea and vomiting (RR 0.46 (95% CI [0.33; 0.65])).

CONCLUSION: Postoperative mobilization may reduce major complications, hospital stay and accelerate recovery, primarily as a part of an ERAS protocol. However, certainty of evidence remains very low. Most studies had a serious risk of bias, highlighting the need for high-quality RCTs.