Optimizing Sedation Protocols Through Early Postoperative Mobilization: A Retrospective Analysis

Abstract

Background: Sedation depth during surgery significantly impacts postoperative outcomes. Deeper sedation levels are associated with delayed recovery, increased complications, and higher mortality rates. Optimizing sedation protocols is essential for improving patient outcomes. We aimed to evaluate the effects of mild versus deep seda-tion on postoperative recovery, complications, and mortality in elective surgical patients. Materials and Methods: This retrospective cohort study analyzed postoperative outcomes based on sedation depth in patients undergoing elective surgery. The study was conducted at a tertiary university hospital, specifically at Gaziantep City Training and Research Hospital, Department of Anesthesiology and Reanimation. A total of 320 adult patients (≥18 years) who underwent elective surgeries under sedation between 2023 and 2025. Patients were divided into two groups: Group A (mild sedation) and Group B (deep sedation). Inclusion criteria included complete medical records and documented postoperative mobilization data. Exclusion criteria were ICU admissions postop-eratively and incomplete records. The primary outcome measures included time to first mobilization, length of hospital stay, and mortality rates. Secondary outcome measures encompassed the incidence of complications, including pulmonary embolism, infection, and thrombosis, as well as postoperative pain levels and patient satisfac-tion scores. Results: Patients in Group A exhibited faster mobilization (12.5 ± 3.7 hours vs. 18.8 ± 4.1 hours, p < 0.001), shorter hospital stays (3.6 ± 1.1 days vs. 5.1 ± 1.3 days, p < 0.001), and lower mortality rates (4.9% vs. 11.3%, p = 0.03) compared to Group B. Deep sedation was a significant risk factor for mortality (OR: 2.8, 95% CI: 1.8–4.4, p = 0.01), with higher propofol and fentanyl doses contributing to adverse outcomes. Delayed mobilization (OR: 1.18 per hour, p = 0.008) and prolonged hospital stays (OR: 1.32 per day, p = 0.001) further increased mortality risk. Conclusions: Mild sedation protocols are associated with improved postoperative outcomes, including faster re-covery, fewer complications, and reduced mortality. Tailored sedation strategies and early mobilization programs are critical for optimizing perioperative care.

Keywords

• Sedation depth
• postoperative outcomes
• mild sedation
• deep sedation
• early mobilization

Ethical Statement

The study was designed as a descriptive, retrospective investigation. Ethical approval was received from Health Science University local ethics committee (approval number: 15.12.2024/12-1).

Postoperatif Hızlandırılmış Mobilizasyonun Sedasyon Protokolleri Üzerine Etkisi: Retrospektif Bir Analiz

Abstract

Amaç: Cerrahi sırasında sedasyon derinliği, postoperatif sonuçlar üzerinde önemli etkilere sahiptir. Derin sedasyon seviyeleri; iyileşmenin gecikmesi, komplikasyonların artması ve mortalite oranlarının yükselmesiyle ilişkilidir. Sedas-yon protokollerinin optimize edilmesi, hasta sonuçlarını iyileştirmek açısından kritik öneme sahiptir. Bu çalışmada, elektif cerrahi uygulanan hastalarda hafif ve derin sedasyonun postoperatif iyileşme, komplikasyonlar ve mortalite üzerine etkilerini değerlendirmeyi amaçladık. Materyal ve Metod: Bu retrospektif kohort çalışmada, 2023–2025 yılları arasındaGaziantep Şehir Hastanesi Aneste-ziyoloji ve Reanimasyon Kliniği'nde elektif cerrahi geçiren 320 yetişkin hasta (≥18 yaş) değerlendirildi. Hastalar sedasyon derinliğine göre iki gruba ayrıldı: Grup A (hafif sedasyon) ve Grup B (derin sedasyon). Dahil edilme kriter-leri; eksiksiz tıbbi kayıtların ve postoperatif mobilizasyon verilerinin mevcut olmasıydı. Postoperatif yoğun bakım ünitesine yatırılan ve eksik kayıtları olan hastalar çalışma dışı bırakıldı. Birincil sonuç ölçütleri; ilk mobilizasyona kadar geçen süre, hastanede kalış süresi ve mortalite oranlarıydı. İkincil sonuç ölçütleri ise; pulmoner emboli, enfeksiyon, tromboz gibi komplikasyonların insidansı, postoperatif ağrı düzeyleri ve hasta memnuniyeti puanlarıydı. Bulgular: Hafif sedasyon uygulanan Grup A'da, ilk mobilizasyona geçiş süresi daha kısa (12.5 ± 3.7 saat vs. 18.8 ± 4.1 saat, p < 0.001), hastanede kalış süresi daha az (3.6 ± 1.1 gün vs. 5.1 ± 1.3 gün, p < 0.001) ve mortalite oranı daha düşüktü (4.9% vs. 11.3%, p = 0.03) (Grup B’ye kıyasla). Derin sedasyon, mortalite için anlamlı bir risk faktörüydü (OR: 2.8, %95 GA: 1.8–4.4, p = 0.01) ve yüksek doz propofol ve fentanil kullanımı olumsuz sonuçlara katkı sağladı. Gecik-miş mobilizasyon (OR: 1.18/saat, p = 0.008) ve uzamış hastane yatışı (OR: 1.32/gün, p = 0.001) da mortalite riskini artıran faktörler olarak belirlendi. Sonuç: Hafif sedasyon protokolleri, daha hızlı iyileşme, daha az komplikasyon ve daha düşük mortalite oranları ile ilişkilidir. Kişiye özel sedasyon stratejileri ve erken mobilizasyon programları, perioperatif bakımın optimize edilme-sinde kilit rol oynamaktadır.

Keywords

• Sedasyon derinliği
• postoperatif sonuçlar
• hafif sedasyon
• derin sedasyon
• erken mobilizasyon

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