Practices and Barriers to Early Mobilization in Intensive Care Unit Post Head and Neck Cancer Surgeries: An Observational Study.

BACKGROUND

Head and neck cancer (HNC) is a growing global health concern, with rising incidence in India. Patients undergoing HNC surgery experience postoperative challenges due to altered airway anatomy and complex reconstruction. Enhanced Recovery After Surgery (ERAS) protocols recommend early mobilization (EM) to improve postoperative outcomes; however, its implementation remains inconsistent.  Evidence regarding EM practices in this population is limited. This study aimed to evaluate EM practices and their barriers in post HNC surgery patients in a tertiary care setting.

METHODS

A prospective observational study was conducted among adults undergoing HNC surgery. Patients with neurological deficits or preoperative non-ambulatory status were excluded. Mobilization was assessed daily until postoperative day (POD) 5 using the ICU Mobility Scale (IMS). Barriers to EM were documented using a validated checklist and categorized into three domains. Logistic regression analyses were performed to identify factors associated with non-ambulatory status (IMS<5). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. A p<0.05 was considered statistically significant.

RESULTS

Among the 69 patients included, 69.6% patients received in-bed exercises, while 27.5% had not been mobilized on POD 1. On POD 3, 23.1% were ambulated with assistance. More than 75% of the patients were ambulated and shifted to the wards by POD 5. Major functional and clinical barrier domains included nasotracheal intubation (75.4%), respiratory distress (53.6%) and free flap reconstruction (28.9%). The system-provider domain included low prioritization of EM (46.4%) and communication gaps among healthcare professionals (7.26%). This domain was independently associated with non-ambulatory status (aOR 0.402, 95% CI 0.172-0.817, p=0.020).

CONCLUSION

EM practices showed a consistent but gradual improvement over the five postoperative days. Though patient related barriers were common, the overall mobility outcomes were mainly determined by the system-provider domain of barriers. Addressing barriers to EM is crucial for enhancing its practice and ensuring adherence to EM protocols.