Osteopathic Manipulative Treatment Protocol for Postoperative Care Following Abdominal Surgery: A Quality Improvement Project

TL;DR

This study tested using osteopathic manipulative treatment (OMT) to reduce hospital stays after abdominal surgery, finding some benefits for patients with open procedures.

Contribution

The study introduces a standardized OMT protocol for postoperative care and evaluates its impact on length of stay.

Findings

The OMT group had a non-significant reduction in median length of stay (LOS) compared to the baseline group.

Patients with open surgical procedures showed a significant reduction in LOS and postoperative LOS.

No significant differences were observed in secondary outcomes like time to first bowel movement or readmission rates.

Abstract

Background

Postoperative ileus (POI) is a common condition that increases length of stay (LOS) and resource utilization. However, treatment consists primarily of supportive care. No workflow addressing measures to promote early bowel function recovery following abdominal surgery was in place at Mayo Clinic Health System Hospital in Mankato. Osteopathic manipulative treatment (OMT) may provide a cost-effective and low-risk option for reducing LOS of surgical patients. The primary aim of this quality improvement project was to decrease LOS of patients at risk for POI following abdominal surgery by implementing a standardized OMT protocol at Mayo Clinic Health System Hospital in Mankato, MN.

Methods

This was a single-center, non-randomized, mixed retrospective-prospective quality improvement project taking place from 2021-2023 taking place at Mayo Clinic Health System Hospital in Mankato, MN. Surgical patients admitted for abdominal surgery with an expected length of stay greater than a day were invited to participate and receive treatment with a pre-defined OMT treatment protocol including seven techniques. Patients under 18 were excluded. A total of 33 patients were enrolled over two cycles, February 1, 2022 - April 30, 2022, and February 1, 2023 - April 30, 2023. A baseline comparison group of 55 patients was retrospectively compiled following these same criteria over a period from January 1, 2021, to April 30, 2021. The primary outcome measured was LOS in days. Secondary outcomes were time to first bowel movement, time to first flatus, 30-day readmission rate, and postoperative LOS.

Results

The baseline group had a median LOS of 7.0 days and while the OMT group had a median LOS of 6.0 days resulting in a non-significant median difference of -1 days [Hodges-Lehmann estimator: -1, 95% CI (-3.0, 0.00), p=0.128] as well as an effect size r=-0.19 [95% CI (-0.44, 0.03)] favoring the OMT group. No significant difference was found in secondary outcomes. Subgroup analysis revealed a significant reduction in median LOS [Hodges-Lehmann estimator: -2.99, 95% CI (-5.00, -1.00), p=0.011, r=-0.38] and postoperative LOS [Hodges-Lehmann estimator: -2.00, 95% CI (-3.99, 0.00), p=0.028, r=-0.33] in patients who underwent open surgical procedures.

Conclusions

In this quality improvement (QI) initiative, the incorporation of a standardized OMT protocol was associated with a non-significant reduction in LOS and postoperative LOS. However, patients undergoing open surgical procedures did show a significant reduction in both LOS and postoperative LOS. These findings suggest the feasibility of this protocol; however, due to the limitations of the study, they warrant further investigation in properly powered, randomized-controlled trials.

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