Impeding factors of early rehabilitation postoperatively after rheumatoid toe arthroplasty: a retrospective cohort study

Abstract Background: It is important to promote early ambulation postoperatively but there are many factors that can hinder the possibility of walking after surgery. Studies have been done to research the benefits related to early ambulation postoperatively but few are focused on patients that have rheumatoid arthritis (RA). We retrospectively investigated the incidence and predictors of the inability to start walking on the first postoperative day (POD) after rheumatoid toe arthroplasty. Methods: RA patients who underwent toe arthroplasty at an academic teaching hospital were retrospectively reviewed. We divided patients into the two groups: possible group, who were able to walk on the first day postoperatively and impossible group, who were unable to walk on the first day postoperatively. The primary outcome was odds ratio (OR) with a 95% confidence interval (CI) between various patient factors and the impossible group with logistic regression analysis. The post hoc analysis for association between anesthesia methods and postoperative outcome was carried out. Results: A total of 300 patients were included and divided into two groups: possible group (n = 191) and impossible group (n = 109). The incidence of postoperative nausea and vomiting (PONV) before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22-4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block (PNB) was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04-1.59, P = 0.003], [OR = 0.41, 95% CI 0.20-0.79, P = 0.010], respectively. In the post hoc analysis, incidence of PONV was highly associated with postoperative intravenous continuous opioid (48.7%, P < 0.0001) compared to regional analgesia; PNB (11.3 %) and epidural (26.7%). Conclusions: In our study, the incidence of PONV and inadequate postoperative pain management hindered early rehabilitation. Adding PNB to general anesthesia had an advantage for postoperative rehabilitation and decreased PONV after rheumatoid toe surgery.