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Improving postoperative mobilisation rates in patients undergoing elective major hepatopancreatobiliary surgery
  1. Jun Han Tang1,
  2. Bei Wang1,
  3. Jie Ling Jaclyn Chow1,
  4. Priscilla M Joseph1,
  5. Jia Ying Chan1,
  6. Nursharazilla Abdul Rahman1,
  7. Yi Hui Low1,
  8. Yen Pin Tan1,
  9. Vishalkumar G Shelat2
  1. 1 General Surgery, Tan Tock Seng Hospital, Singapore
  2. 2 Hepato-Pancreatico-Biliary Surgery, Tan Tock Seng Hospital, Singapore
  1. Correspondence to Vishalkumar G Shelat, Hepatopancreatobiliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore; vishal_g_shelat{at}


Background Early mobilisation reduces postoperative complications such as pneumonia, deep vein thrombosis and hospital length of stay. Many authors have reported poor compliance with early mobilisation within Enhanced Recovery After Surgery initiatives.

Objectives The primary objective was to increase postoperative day (POD) 2 mobilisation rate from 23% to 75% in patients undergoing elective major hepatopancreatobiliary (HPB) surgery within 6 months.

Methods We report a multidisciplinary team clinical practice improvement project (CPIP) to improve postoperative mobilisation of patients undergoing elective major HPB surgery. We identified the common barriers to mobilisation and analysed using the fishbone or cause-and-effect diagram and Pareto chart. A series of Plan–Do–Study–Act cycles followed this. We tracked the rate of early mobilisation and mean distance walked. In the post hoc analysis, we examined the potential cost savings based on reduced hospital length of stay.

Results Mobilisation rate on POD 2 following elective major HPB surgery improved from 23% to 78.9%, and this sustained at 6 months after the CPIP. Wound pain was the most common reason for failure to ambulate on POD 2. Hospital length of stay reduced from a median of 8 days to 6 days with an estimated cost saving of S$2228 per hospital stay.

Conclusion Multidisciplinary quality improvement intervention effort resulted in an improved POD 2 mobilisation rate for patients who underwent elective major HPB surgery. This observed outcome was sustained at 6 months after completion of the CPIP with potential cost savings.

  • Health services administration & management
  • quality in healthcare
  • surgery
  • hepatobiliary surgery

Statistics from


  • Contributors Study conception and design: BW, JLJC, PMJ, JYC, NAR, YHL, YPT, VGS. Acquisition of data: BW. Analysis and interpretation of data: JHT. Drafting of manuscript: JHT, VGS. Critical revision: JHT, VGS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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