International Journal of Current Research and Review
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IJCRR - Vol 13 Issue 13, July, 2021

Pages: 210-217

Date of Publication: 05-Jul-2021


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Effects of Early Ambulation in Post Operative Recovery Among Women with Abdominal Hysterectomy

Author: Amruta Taksande, Manjusha Mahakalkar, Vaishali Taksande

Category: Healthcare

Abstract:Background: Amazed all hysterectomy, most frequently performed surgical procedures in women is abdominal hysterectomy. If early ambulation is not done post operatively, there is chance of different complications such as eruption, deficient veins, lowers respiratory tract infection, minor bleeding and venous thrombo-embolism, blockage of pulmonary artery, paraplegic ileum and etcetera. Objectives: 1) To assess post operative recovery among the women who have undergone abdominal hysterectomy in control group.2) To assess the effectiveness of early ambulation in post operative among the women who have undergone abdominal hysterectomy in experimental group. 3) To compare post-operative recovery among the women who have undergone abdominal hysterectomy in control and experimental group. Methods and Materials: A quantitative research approach was used in this study with quasi-experimental group study research design and sample size was 100 were selected by a Non-Probability Purposive Sampling Technique. An observational checklist and post-operative related questionnaire was used to collect the data. Results: In experimental group, duration of post operative recovery among women who has undergone abdominal hysterectomy is less as compared to post-operative recovery among women who has undergone abdominal hysterectomy in control group. Also structured questionnaire related to post-operative recovery interpret that early ambulation is effective one in experimental group as compared to in control group. Conclusion: Early ambulation is effective and helps to recover soon.

Keywords: Early ambulation, Post operative recovery, Abdominal hysterectomy, Abdominal surgery, Gynecological operations

Full Text:

INTRODUCTION

          Typically a gynecologist performs  hysterectomy, which is a cut-out or surgical removal of the vagina. Hysterectomy may be complete body removal, known as total hysterectomy or fundus, and cervix uterine; sometimes referred to as partial removal of  uterine body known as partial hysterectomy while keeping the cervix intact, known as supra cervical hysterectomy. It is the most frequently performed surgical procedure. More than 600,000 hysterectomies have been conducted in 2003.1,7 In favorable cases, more than 90 % of these procedures are conducted in the US alone. Such high rates in industrialized world have led major controversy that hysterectomies are performed largely for unwarranted and unnecessary reasons.2,3

               As a last resort to cure such intractable uterine/reproductive system problems, hysterectomy is usually recommended. These disorders may include uterine fibroids, extreme intractable endometriosis, adenomyosis, chronic pelvic pain, frequent obstetric hemorrhage, and various forms of vaginal prolapse, and sometimes serious pre-placenta and placenta accrete.3,4,5

MATERIALS AND METHODS

The study was based on a quantitative research approach with a quasi-experimental group study research design. A Non-Probability purposive sampling technique was used and 100 samples of women from selected hospitals. Inclusion criteria were women between ages of 20 and 50 years and older and women who want to take part in this study. Exclusion criteria were women who are not available at the time of study and women who are having post abdominal hysterectomy complications. Tools were an observational checklist and post-operative related questionnaire. The data gathering process began from 12th Aug to 31st Aug 2019. The investigator visited the area in advance and obtained the necessary permission from the concerned authorities. The institutional Ethics Committee in its meeting  held  on 12/12/2018 has approved the study and the Referral number is 7758. Based on the objectives and the hypothesis the data were analyzed by using various statistical tests. In control group, early ambulation is not suggested while in experimental group, early ambulation is suggested and checklist is assessed after 5-6 days of early ambulation.

RESULTS

Section 1

Part I – Distribution of participants within the control group according to their demographic variables.

Table no 1 Shows that, 6(12%) of 20-29yrs age, 9(18%) 30-39years old, 24(48%) 40-49yrs, 11(22%)50 yrs & above. 37(74%) married, no subjects  unmarried, 3(6%)  divorced or separated, 10(20%) widow. 3(6%) illiterate, 18(36%) had primary education, 9(18%) had secondary education,  13(26%)higher secondary & 7(14%) graduated & above. 35(70%)  housewife, 4(8%) laborer, 6(12%)  business women, 1(2%) on government job, 4(8%) on private job.24(48%)  knew & 26(52%) didn’t  know about abdominal hysterectomy, in 8(16%)  source of knowledge was family, in 5(10%) it was friends, in 11(22%) source of knowledge was health personnel.

Part II – Distribution of participants in the experimental group as per their demographic variables.

Table no 2: No subjects were of 20-29 year age group, 11(22 %) were of 30-39 yrs, 19(38 %) 40-49 yrs age, 20(40%) were 50 yr-old & above. 36(72%)  married, 3(6%) single, none divorced or separated, 11(22%) were widow. 7(14%) were illiterate,14(28%) primary education, 8(16%) secondary education,  13(26%)  higher secondary, 8(16%) is graduated & above. 30(60%) housewife, 7(14%) labourer, 5(10%)  business women, 3(6%) on government job and 5(10%) on private job.23(46%) subjects knew whereas 27(54%) did not know about abdominal hysterectomy, in 5(10%) source of knowledge was media, in 3(6%) it was family, in 2(4%) it was friends, in 13(26%) source of knowledge was health personnel.

Section 2

Part I – Checklist to assess the post-surgical recovery among women who have suffered abdominal hysterectomy in Control group.

Table no. 3 contain 29(58%) On day 4 & 21(42%) women on 5th day rest on  bed's edge.

 29(58%) on 4th day & 21(42%) were sitting on bed on POD5.

29(58%) on the 4th day & 21(42%) moved out of bed on POD5.

20(40%) on day 4 , 20(40%)on 5th & 10(20%)  were sitting in  chair on 6th day.

2(4%) on day 4, 28(56%) on POD5, 20(40%) walk in ward on day 6th day.

29(58%) on day 5, 21(42%) on POD6 perform walk in ward.

 1(2%) on POD 4, 28(56%) on day 5 & 21(42%) on POD 6 perform stairs up & down.

 22(44%) on day 4, 27(54%) on day 5 & 1(2%) felt decreased intensity of pain on POD6.

 21(42%) on day 4, 28(56%) on POD 5 and 1(2%) on POD6 felt decreased level of discomfort.

 5(10%) on day 4, 39(78%) on day 5 and 6(12%) on POD6 felt decreased level of dependency in performing daily activities.

5(10%) on day 4, 33(66%) on day 5, 12(24%)on POD6 passed flatus.

Part II Checklist to assess the efficacy of early ambulation in post-operational recovery among women who have undergone abdominal hysterectomy in Experimental group.

Table no. 4 shows the following data

26(52%) on POD2 while 24(48%) sat on bed’s edge on POD3.

22(44%) on POD2, 28(56%) were sitting in bed on POD3.

22(44%) on POD2, while 28(56%) women shifted out of bed on day 3.

17(34%) on day 2, 30(60%) women on day 3, 3(6%)  on day 4 were sitting at chair.

25(50%) on day 3, 25(50%) women walk in ward on POD 4.

22(44%) on POD 3, 28(56%) on POD4 perform walking in corridor.

22(44%) on POD 3, 28(56%) women on day 4 perform stairs up and down.

14(28%) on POD2, 32(64%) on POD 3, 4(8%) on day 4 felt decreased intensity of pain.

14(28%) on day 2, 32(64%) on day 3, 4(8%) on day 4 felt decreased level of discomfort.

19(38%) on day 2, 28(56%) on day 3 and 3(6%) on day 4 felt decreased level of dependency in performing daily activities.

9(18%) on day2, 35(70%) on day 3, 5(10%) on day 4 and 1(2%) women on day 5 passed flatus.

Section 3

Table no. 5 shows a Comparison between the control and experimental group 

In control group, 29(58%) on 4th day, 21(42%) on 5th day while in experimental group, 26(52%) on 2nd day & 24(48%) women on 3rd day perform a sitting on edge of bed.

In control group, 29(58%) on 4th day, 21(42%) on 5th day wherein among experimental group, 22(44%) on 2nd day, 28(56%) subjects on 3rd day perform a sit to stand by bed.

29(58%) on 4th day 21(42%) on 5th day, in control group, 22(44%) on 2nd day, 28(56%) women on 3rd day in experimental group moved out of bed.

In the control group, 20(40%) on the 4th day, 20(40%) on the 5th day, 10(20%) on the 6th day whereas in the experimental group, 17(34%) on the 2nd day, 30(60%) on the 3rd day 3(6%) subjects on 4th day sat to stand by the chair

2(4%) women on 4th day, 28(56%) on 5th day, 20(40%) on 6th day in the control group whereas 25(50%) on 3rd day, 25(50%) women on 4th day in the experimental group performed walking in the ward.

In control group, 29(56%) subjects on 5th day, 21(42%) on 6th day while in experimental group, 22(44%) on 3rd day, 28(56%) on 4th day performed walking in corridor.

1(2%) on 4th day, 28(56%) on 5th day 21(42%) on 6th day in control group while 22(44%) on 3rd day, 28(56%) on 4th day in experimental group performed stairs up and down.

In the control group, 22(44%) on the 4th day, 27(54%) on the 5th day 1(2%) on the 6th day whereas in the experimental group, 14(28%) on the 2nd day, 32(64%) on 3rd day, 4(8%) women on 4th day had decreased intensity of pain.
21(42%) on 4th day, 28(56%) on 5th day 1(2%) on 6th day in control group and 14(28%) on 2nd day, 32(64%) on 3rd day, 4(8%) subjects on 4th day felt decreased level of discomfort.

In the control group, 5(10%) on the 4th day 39(78%) on the 5th day, 6(12%) on the 6th day wherein in the experimental group, 19(38%) on the 2nd day, 28(56%) on 3rd day, 3(6%) women on 4th day had decreased level of dependency in performing daily activities.

 5(10%) on 3rd day, 33(66%) on 4th day, 12(24%) on 6th day in the control group whereas 9(18%) on 2nd day, 35(70%) on 3rd day, 5(10%) on 4th day 1(2%) subjects on 5th day in the experimental group passed flatus.

Section 4-

Structured questionnaire related post-operative recovery in the control and experimental group and comparison between them.

Table no. 6(a) having information about control group, duration of catheterization was 19-24hrs in 10 (20%) and 25-30 hrs in 40 (80%). In experimental group, it was 6-12hrs in 24(48%), 13-18hrs in 3(6%), 19-24hrs in 14(28%) and 25-30 hrs in 9(18%) women.

Table no.6(b) shows, control group, 8(16%) self void <1hr, 36(72%) between 1-2hr and 6(12%) self void>2hr however, in experimental group, 48(96%) women self void in <1hr, 2(4%)1-2 hr after removal of catheter.

        In control group, 22(44%) women were having 301-450 ml & 28(56%) having >450 ml urine output. In experimental group, 5(10%) having 150-300 ml,4(8%) having 301- 450ml and 41(82%) having >450 ml urine output.

Table no. 6(c) having the information,In control group, 45(90%) 1-2 analgesic, 5(10%) required 3-4 analgesics & in experimental group, 49(98%) 1-2, 1(2%) required 3-4 analgesics after hysterectomy.

        In the control group, 6(12%) for 7-8 days, 44(88%) for >8 days while in the experimental group, 28(56%) for 4-5 days, 8(16%) for 6-7 days and 14(28%) women for 7-8 days stays in the hospital.

DISCUSSION

Similar study was conducted which was eventual adherent study in which amide 50 patients who had undergone abdominal hysterectomy from June 1, 2003 to December 31, 2003. Study aimed to discover early activity's security and viability. The study concluded that in patients with hysterectomy, the early operation is possible and healthy. After 2 days of ambulation, most of the clients (78%) were able to ambulate 100feet.4,5,6

       This study shows that, in experimental group, duration of post operative recovery among women is less as compared to post-operative recovery among women who has undergone abdominal hysterectomy in control group. Also structured questionnaire related to post-operative recovery interpret that early ambulation is effective one in experimental group as compared to in control group in which only post-operative recovery checked and early ambulation not suggested.7,8,9

CONCLUSION

Therefore, healthcare providers at all levels need to understand the importance of early ambulation after abdominal hysterectomy, become educated on the protocols and procedures of practice in order to make early ambulation on day zero new standard of care for all postoperative patients. Conflict of interest is nil and the source of funding was self. Early ambulation improved the state and aids in early discharge.

ACKNOWLEDGEMENT

We would like to thank all the participants and the authorities of the institutions for their cooperation throughout the data collection.

Conflict of Interest : None

 Source of Funding: None

References:

1.Pinar G, Okdem S, Dogan N, Buyukgonenc L, et al. The Effects of hysterectomy on Body Image, self esteem and Martial adjustment in Turkish women with Gynaecologic cancer. Clin J Onc Nur. 2012; 16(3):99-104.

2. Elizabeth A Stewart, Wanda K Nicholson, et al. The burden of uterine fibroids for American-American women: results of a national survey. J Wom Hea.

2013:22(10); 807-816.

3. Daniel Morgan, Across the country, fewer women are getting hysterectomies and those who do are choosing less invasive methods with no hospital stays, saving millions in health care costs. Inst Health Pol Inn. 2018;23 (9): 142-145.

4. Earnest VV. Procedure Checklist to Accompany Caroline Bunker Rosdahl's Textbook of Basic Nursing. Lippincott; 1999; 142-145.

5. Priya SP, Roach EJ, Lobo DJ. Effectiveness of pre-operative instruction on knowledge, pain, and selected post-operative behaviours among women undergoing abdominal hysterectomy in selected hospital, Bangalore, Karnataka. Man J Nur Hea Sci. 2017; 3(1):3-9.

6. Katz A. Sexuality after hysterectomy. J Obst Gynec Neon Nur. 2002 May; 31(3):256-62.

7. Banos Calbo M. Enhanced Recovery Programme in Abdominal Surgery. J Obst Gynec NeonNur.2018:30(4): 875-879.

8.  Behjati AZ. An Evaluation of the Historical Importance of Fertility and Its Reflection in Ancient Mythology. Avic Res Insti. 2016; 17(1): 2-9.

9. Chaudhari S. Psychiatric effects of Hysterectomy. J Adv Res. 1995; January; 51(1): 27–30.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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