Analysis of pulmonary function and comparison of time to early mobilization in patients undergoing laparoscopic bariatric surgery: a quasi-experimental study

Silva, Fernanda Cardoso; Via, Fabiana Della; Germano, Italo Gabriel Ferreira; Terra, Andréia Maria da Silva Vilela; Concon Filho, Admar; Kosour, Carolina

doi:10.1590/1809-2950/e24005524en

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ORIGINAL RESEARCH • Fisioter. Pesqui. 32 • 2025 • https://doi.org/10.1590/1809-2950/e24005524en linkcopy

Analysis of pulmonary function and comparison of time to early mobilization in patients undergoing laparoscopic bariatric surgery: a quasi-experimental study

Análisis de la función pulmonar y comparación del tiempo hasta el inicio de la movilización temprana en pacientes sometidos a cirugía bariátrica por laparoscopia: estudio cuasiexperimental

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Early mobilization applied after bariatric surgery aims to reduce postoperative complications. Notably, there is no consensus on the appropriate time to start it. This study aimed to analyze the recovery of lung function and length of stay in patients undergoing bariatric surgery at different mobilization times. Quasi-experimental, interventional study with 167 patients divided into three groups: the first 55 patients began early mobilization 6 hours after surgery (G6); other 55 patients started after 4 hours (G4) and the last 57 patients started after 2 hours (G2). Spirometry was performed preoperatively and before mobilization, the measurements obtained were forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum voluntary ventilation (MVV) and forced expiratory flow by 25-75% (FEF25-75%). There was a prevalence of females (82.04%), hospitalization time was shorter in G2 (p<0.050) and vital signs remained at physiological values. There was a significant reduction in FEV1, FVC, MVV, FEF25-75% and PEF values in the immediately after surgery, followed by a gradual increase (p≤0.05) as the days progressed. This study identified that the physiotherapeutic protocol initiated 2, 4 or 6 hours after surgery was effective regarding hemodynamic stability, reduction of hospitalization time and recovery of lung function over time in patients undergoing bariatric surgery. However, no difference was observed regarding lung function in relation to early mobilization groups.

Keywords|
Early Mobilization; Respiratory Physical Therapy; Postoperative Period

Characteristic	Group 6h n=55	Group 4h n=55	Group 2h n=57	p-value
Age (years old)
median±IQ (50%)	34±11.00	34±13.00	36±12.50	0.11
BMI (Kg/m²)
median±IQ (50%)	39.52±3.80	39.34±4.18	39.47±4.31	0.93
Length of hospital stay (days)
median±IQ (50%)	5±0.00	4±0.00	4±0.00	0.00 (G2≠G4; G2≠G6)
Sex (F/M)	45/10	44/11	48/9	-
Smoking habits (%)
Non-smokers	37 (22.15%)	49 (29.34%)	46 (27.54%)	-
Smokers	6 (3.59%)	1 (0.59%)	11 (6.58%)	-
Former smokers	12 (7.18%)	5 (2.99%)	0	-
Spirometry
Normal	51 (30.53%)	46 (27.54%)	52 (31.13%)	-
Restrictive disorder	2 (1.19%)	4 (2.39%)	1 (0.59%)	-
Obstructive disorder	0	3 (1.79%)	2 (1.19%)	-
Mixed disorder	2 (1.19%)	2 (1.19%)	0	-

Parameter	Preoperative median±IQ (50%)	iPO median±IQ (50%)	PO1 median±IQ (50%)	PO2 median±IQ (50%)	Intragroup p-value*
SpO₂ (%)
G6h	97.00±2.00	97.00±2.00	97.00±1.00	97.00±1.00
G4h	96.00±3.00	96.00±3.00	96.00±2.00	97.00±2.00	0.32
G2h	97.00±3.00	97.00±3.00	96.00±3.50	96.00±2.00	0.00
intergroup p-value**	0.00	0.02	0.01	0.01	0.00
MAP (mmHg)
G6h	93.33±6.70	93.33±10.00	93.33±13.33	93.33±13.27
G4h	96.66±10.03	93.33±10.00	90.00±10.03	90.00±6.67	0.00
G2h	90.00±10.00	90.00±10.00	90.00±10.00	90.00±10.00	0.00
intergroup p-value**	0.00	0.02	0.17	0.41	0.01
HR (bpm)
G6h	82.00±16.00	84.00±14.00	84.00±15.00	82.00±15.00
G4h	83.00±9.00	84.00±10.00	81.00±12.00	82.00±10.00	0.07
G2h	79.00±12.00	79.00±10.00	78.00±11.00	80.00±12.50	0.89
intergroup p-value**	0.14	0.05	0.06	0.10	0.72
RR (bpm)
G6h	14.00±4.00	13.00±4.00	13.00±2.00	13.00±2.00
G4h	15.00±4.00	14.00±3.00	14.00±4.00	14.00±3.00	0.00
G2h	16.00±4.50	14.00±5.00	14.00±4.00	14.00±3.00	0.00
intergroup p-value**	0.00	0.00	0.00	0.00	0.00

Parameter	Postoperative median±IQ (50%)	iPO median±IQ (50%)	PO1 median±IQ (50%)	PO2 median±IQ (50%)	p value intragroup*
VEF1
G6h	3.06±0.68	1.59±0.58	1.86±0.61	2.299±0.77
G4h	3.12±0.74	1.47±0.75	1.80±0.55	2.36±0.80	0.00
G2h	3.37±1.02	1.89±0.92	2.42±0.93	3.00±0.75	0.00
intergroup p-value**	0.00	0.00	0.00	0.00	0.00
FVC
G6h	3.55±1.09	1.97±0.88	2.16±0.84	2.46±0.74
G4h	3.78±0.85	1.75±0.79	2.10±0.93	2.56±1.06	0.00
G2h	3.80±0.81	1.99±1.17	2.63±0.92	3.23±0.72	0.00
intergroup p-value**	0.04	0.04	0.00	0.00	0.00
MVV
G6h	130.55±25.50	75.42±21.75	85.55±22.88	101.47±28.88
G4h	136.92±35.63	76.55±30.38	85.17±27.38	104.30±31.88	0.00
G2h	141.80±31.69	86.67±31.69	107.67±32.25	128.30±28.88	0.00
intergroup p-value**	0.02	0.01	0.00	0.00	0.00
FEF 25-75%
G6h	3.40±1.10	1.79±1.27	2.16±0.92	3.05±1.46
G4h	3.58±1.42	1.76±0.67	2.23±1.23	2.88±1.18	0.00
G2h	4.00±1.49	2.03±0.81	2.52±1.02	3.40±1.41	0.00
intergroup p-value**	0.01	0.07	0.03	0.02	0.00
PEF
G6h	5.17±2.47	2.31±2.04	2.98±1.99	3.78±2.25
G4h	4.89±3.03	2.10±1.26	2.95±1.50	3.85±2.22	0.00
G2h	6.35±2.96	3.21±1.22	4.00±1.92	5.10±2.41	0.00
intergroup p-value**	0.00	0.00	0.00	0.00	0.00

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[TFN1] n: absolute number; %: Percentage; median±IQ (50%): median±50% of the interquartile range, p-value=5%; BMI: body mass index; Kg: kilogram; m²: square meters; F/M: female/male.