Is mobility after trauma laparotomy associated with surgical site infections?

Authors:
Lillian S Kao, Mokunfayo Fajemisin, Renee W, Green, Stephanie Martinez Ugarte, William Rieger

Body of Abstract:
Background:
Traumatic injury can drastically affect mobility in patients, regardless of surgical intervention. Enhanced Recovery After Surgery (ERAS) protocols that include early mobilization after elective and emergency surgery have shown a decrease in surgical site infections (SSIs). Although only certain ERAS components are applicable to emergency surgery, early mobilization may be feasible. However, few studies have explored the existing prevalence of early mobilization after emergency trauma laparotomy or explored the association between physical mobility and SSIs. We hypothesized that degree of post-laparotomy, as denoted by the Activity Measure for Post-Acute Care (AMPAC) score, and time to mobilization, are associated with lower SSI rates in trauma patients.

Methods:
A retrospective analysis of adults (>16 years old) who underwent trauma laparotomy from 6/2022 – 6/2023 was performed. Patients who died without or never received physical therapy (PT) were excluded. Patient demographics, hospitalization details, SSI status per Centers for Disease Control guidelines, and inpatient PT details of days to mobilization, as denoted by PT initiation, and AMPAC scores at first post-operative PT session were collected from the medical record. AMPAC scores are derived from 6 activities of daily living scored 1-4 for a max of 24 meaning full function. Descriptive statistics, univariate, and multivariable analysis were performed using known SSI-associated factors.

Results:
Of 160 patients, 120 were male (75.5%), their median age was 34 (IQR 23-45) with a median injury severity score of 22 (IQR 12-32). Their median AMPAC score was 16 (IQR 9-24) and median time to mobility was 2 days (IQR 0-4) (Table). Seventeen (11%) patients had an SSI. Univariate regression showed no significant association between initial AMPAC scores and SSIs (OR 1.0, 95% CI 0.91-1.09, p=0.93), but time to mobilization was significantly associated (OR 0.93, 95% CI 0.91-1.09, p=0.01). In separate models, each adjusted for injury severity score, AMPAC scores were not associated with SSIs (OR 1.0, 95% 0.88-1.10, p=0.85), while days to mobilization remained significantly associated (OR 1.04, 95% CI 0.94-1.02, p<0.01). Conclusions: This single center analysis showed that time to initial mobilization but not initial physical function per AMPAC scores was associated with SSI. While multiple confounders may impact these metrics, the data suggest an opportunity for earlier patient mobilization after emergency trauma laparotomy, potentially as a component of an ERAS protocol.