Importance of early postoperative mobilization: comprehensive review.

Abdulaziz Alsuwaylihi, Dominic O'Connor, Girish P Joshi, Henrik Kehlet, Dileep N Lobo

Journal: BJS open 2026;10(2):

PMID: 41873570

Abstract

BACKGROUND

Early postoperative mobilization is an important component of enhanced recovery after surgery protocols, which aim to improve postoperative outcomes. This narrative review explores the historical evolution, physiological impact, and clinical advantages of early postoperative mobilization.

METHODS

The Embase, MEDLINE, and PubMed databases were searched, without time restrictions, for studies related to postoperative immobilization and mobilization. Randomized clinical trials, observational studies, systematic reviews, meta-analyses, and clinical guidelines pertaining to adult surgical patients were reviewed, aiming to summarize the historical background, the pathophysiology of immobilization, the clinical outcomes of early postoperative mobilization, anaesthetic aspects, adverse events, limitations of the current evidence, and key barriers.

RESULTS

Extended postoperative immobilization was consistently linked with negative physiological outcomes, including muscle atrophy, insulin resistance, venous thromboembolism, and postoperative pulmonary complications. Several studies indicated that each additional day of postoperative bed rest was associated with a nearly threefold increase in the risk of postoperative pulmonary complications, and remaining on bed rest for more than 3 days was associated with a 2.7-fold higher risk of postoperative pneumonia. Conversely, early postoperative mobilization was associated with shorter hospital length of stay, with reductions of up to 34% reported in some surgical populations, and improved functional recovery. However, the effects of early postoperative mobilization on morbidity, quality of life, and mortality were inconsistent across studies.

CONCLUSIONS

Early postoperative mobilization provides significant functional and physiological advantages. However, the strength of evidence supporting its impact on clinical outcomes varies according to surgical subspecialities. To improve implementation and reinforce evidence-based recommendations, future research should focus on standardized definitions of early postoperative mobilization, consistent outcome measures, and higher-quality, subspeciality-specific studies.

Address: Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.; Department of Clinical Nutrition, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.; School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.; Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK.; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.; Divison of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

DOI: 10.1093/bjsopen/zrag016

MeSH Terms: Humans, Early Ambulation, Postoperative Complications, Postoperative Care, Length of Stay, Bed Rest, Enhanced Recovery After Surgery, Quality of Life