• Julia Ma, Rachel Martin, Bokman Chan, Michael Gofeld, Michael P Geary, John G Laffey, and Faraj W Abdallah.
• From the Department of Obstetrics and Gynecology (J.M., M.P.G.) and the Department of Anesthesia (R.M., B.C., M.G., J.G.L., F.W.A.), University of Toronto, Toronto, Ontario, Canada; and the Department of Obstetrics and Gynecology (J.M., M.P.G.) and the Department of Anesthesia (R.M., B.C., M.G., J.G.L., F.W.A.), St. Michael's Hospital, Toronto, Ontario, Canada; the Department of Obstetrics and Gynecology, Dalla Lana School of Public Health (J.M.), Toronto, Ontario, Canada; the Department of Anesthesia, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada (J.G.L., F.W.A.); the Department of Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland (J.G.L.); and the Department of Anesthesiology and Pain Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.).
• Anesthesiology. 2018 Mar 1; 128 (3): 598-608.

BackgroundEarly postoperative ambulation is associated with enhanced functional recovery, particularly in the postpartum population, but ambulation questionnaires are limited by recall bias. This observational study aims to objectively quantify ambulation after neuraxial anesthesia and analgesia for cesarean delivery and vaginal delivery, respectively, by using activity tracker technology. The hypothesis was that vaginal delivery is associated with greater ambulation during the first 24 h postdelivery, compared to cesarean delivery.MethodsParturients having first/second cesarean delivery under spinal anesthesia or first/second vaginal delivery under epidural analgesia between July 2015 and December 2016 were recruited. Patients with significant comorbidities or postpartum complications were excluded, and participants received standard multimodal analgesia. Mothers were fitted with wrist-worn activity trackers immediately postdelivery, and the trackers were recollected 24 h later. Rest and dynamic postpartum pain scores at 2, 6, 12, 18, and 24 h and quality of recovery (QoR-15) at 12 and 24 h were assessed.ResultsThe study analyzed 173 patients (cesarean delivery: 76; vaginal delivery: 97). Vaginal delivery was associated with greater postpartum ambulation (44%) compared to cesarean delivery, with means ± SD of 1,205 ± 422 and 835 ± 381 steps, respectively, and mean difference (95% CI) of 370 steps (250, 490; P < 0.0001). Although both groups had similar pain scores and opioid consumption (less than 1.0 mg of morphine), vaginal delivery was associated with superior QoR-15 scores, with 9.2 (0.6, 17.8; P = 0.02) and 8.2 (0.1, 16.3; P = 0.045) differences at 12 and 24 h, respectively.ConclusionsThis study objectively demonstrates that vaginal delivery is associated with greater early ambulation and functional recovery compared to cesarean delivery. It also establishes the feasibility of using activity trackers to evaluate early postoperative ambulation after neuraxial anesthesia and analgesia.

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