Abstract
<title>Abstract</title> <p> Background Early postoperative mobilization is a key component of Enhanced Recovery After Surgery pathways, yet its adherence in gynecological practice remains suboptimal. This study aimed to evaluate the effectiveness and feasibility of a theory-guided, multifaceted implementation strategy for improving early mobilization after laparoscopic total hysterectomy. Methods A type 2 hybrid effectiveness-implementation study with interrupted time-series (ITS) design was conducted in a 44-bed gynecology surgical ward of a tertiary hospital in South China. Data were collected over 16 weekly time points (8 pre‑implementation, 8 post‑implementation). Barriers were identified using the Consolidated Framework for Implementation Research, and targeted strategies were selected via the Expert Recommendations for Implementing Change taxonomy. The intervention bundle comprised staff simulation training, multidisciplinary consensus, weekly audit and feedback, patient educational videos, and a bedside mobilization checklist. Outcomes were evaluated using the RE‑AIM framework, including adherence, clinical recovery, implementation fidelity, provider adoption, and 8‑week maintenance. Segmented regression was used for ITS analysis. Results A total of 121 patients were included (59 pre-implementation, 62 post-implementation). The proportion of patients mobilized within 24 hours increased from 37.3% to 69.4% ( <italic>p</italic> < 0.001). Time to first ambulation decreased from 25.98 ± 6.17 hours to 22.22 ± 4.34 hours ( <italic>p</italic> < 0.001). Length of stay was reduced from 11.10 ± 4.26 days to 8.92 ± 3.08 days ( <italic>p</italic> = 0.002), and total hospital costs decreased from ¥31,688 ± 12,753 to ¥25,244 ± 7,161 ( <italic>p</italic> = 0.001). No mobilization-related adverse events occurred. Time-series analysis showed a downward trend in ambulation time post-intervention, although slope and level changes did not reach statistical significance. Improvements were sustained at 8-week follow-up. Conclusions The theory-guided, multifaceted implementation strategy significantly and safely improves early mobilization adherence after laparoscopic hysterectomy, with concurrent reductions in length of stay and healthcare costs. These findings support the value of implementation science in bridging the evidence-practice gap in perioperative care. Trial registration: Chinese Clinical Trial Registry (ChiCTR), registration number pending (submitted for retrospective registration on 18 May 2026). Retrospectively registered. </p>