PENGARUH ENHANCED RECOVERY AFTER SURGERY TERHADAP KEMAMPUAN MOBILISASI PADA PASCAOPERASI MODIFIED RADICAL MASTECTOMY

Abstract

Breast cancer is the most common malignant tumor in women worldwide. In Indonesia, according to data from the Indonesian Ministry of Health, breast cancer ranks first in terms of the highest number of cancer cases in Indonesia and is one of the leading causes of cancer-related deaths. Breast cancer treatment depends on the type, stage, size of the cancer, and whether the cancer cells are hormone-sensitive. In oncological surgery, Modified Radical Mastectomy (MRM) remains the standard of care in low- and middle-income countries for stages II and III. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary and multimodal protocol aimed at accelerating post-operative recovery through an evidence-based approach. One of its key components is early mobilization, which is believed to accelerate functional recovery. However, the impact of the ERAS protocol on patients' ability to mobilize after Modified Radical Mastectomy (MRM) has not been extensively studied, particularly in Indonesia.  This study used a quasi-experimental design with two groups, namely the group that received the ERAS protocol intervention and the non-ERAS group. Eight subjects were assigned to each group. Mobility ability was measured using the John Hopkins Highest Level of Mobility (JH-HLM) instrument at 1 hour, 16 hours, and 24 hours post-surgery. Data analysis was performed using statistical tests for mean differences, specifically the Wilcoxon and Mann-Whitney tests. There was a significant improvement in patients' mobility in the ERAS group from 1 hour to 16 hours and 24 hours post-surgery (p<0.05). Additionally, there were significant differences in mobility levels between the ERAS and non-ERAS groups at both 16 and 24 hours (p<0.05), with the ERAS group showing better results. The implementation of the ERAS protocol significantly improved early mobility in patients after MRM surgery compared to the standard protocol. This indicates that ERAS can be an effective approach in medical rehabilitation to accelerate functional recovery and reduce length of hospital stay.