The perioperative program essentially consists of rapid mobilization after surgery, with "out of bed to chair" being the goal of the first day. The goal of subsequent days, up to the day of discharge, are to increase ambulation and to avoid complications. Ambulation should be started as soon as is possible from a point of medical stability. By the time of hospital discharge, an individual should be able to perform all of their basic ADL and also be able to ambulate independently. In individuals where complications or severe debility do not allow for rapid mobilization, the inability to progress rapidly may require consideration of an inpatient acute rehabilitation stay. Pulmonary toilet is a very important component in the prevention of postoperative pneumonia. Chest physical therapy should be aggressively provided by the nursing staff and by the physiotherapy staff to keep secretions well managed. The physiotherapy time devoted to pulmonary toilet should not detract from the time spent on patient mobilization.
The perioperative mobilization program should ideally consist of two sessions per day, and be undertaken 7 d/wk in order to maximize recovery. Therapist experience is essential, and designated therapists should provide these services. All patients need close monitoring of oxygen saturation, and in the case of cardiac arrhythmias or suspected ischemia, telemetric monitoring may also be necessary. The focus of this program is on ambulation and regaining ADL independence, so the main exercises include ambulation training, treadmill training, and bicycle ergometry. As soon as a patient has recovered sufficiently to transfer safely, a bedside bicycle ergometer is advised to allow for increased endurance training.
The educational components of the program at this time are limited. Social work and psychosocial interventions may need to be instituted for sudden family and patient crises. However, the need for intensive services at this time should be limited if a comprehensive preoperative rehabilitation program was followed and these issues identified at that earlier time.
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