Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Abstract

BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

Comparative short-term outcomes of enhanced recovery after surgery (ERAS) program and none-ERAS traditional care in elderly patients undergoing lumbar arthrodesis: a retrospective study

“…Although the compliance of early ambulation was only 70% in our study, the overall time until ambulation postoperatively was greatly shortened. Previous studies have shown that early ambulation is associated with decreased morbidity and adverse events after elective lumbar spine surgery [47]. However, preoperative deterioration of motor function, endurance and coordination makes early ambulation more difficult.…”

“…However, preoperative deterioration of motor function, endurance and coordination makes early ambulation more difficult. And early ambulation is often accompanied by orthostatic intolerance, such as dizziness and nausea, which increases the risk of aspiration and fall [47,48]. Therefore, for elderly patients, early ambulation should be encouraged rather than enforced, and should be accompanied by the presence of professional caregivers and patient confirmation of no obvious discomfort after sitting up.…”

Impact of Compliance with an Enhanced Recovery After Surgery Program on the Outcomes Among Elderly Patients Undergoing Lumbar Fusion Surgery

“…25,26 A recent study has proved that early ambulation after elective lumbar spine surgery is associated with significant improvements in LOS, urinary tract infection (UTI) and ileus. 27 On the other hand, due to factors beyond common discharge criteria, such as logistical and social issues, the delays of elderly patients in discharge directly increase LOS. 28 The other ERAS items were not independently linked to the prognosis indicators in our study.…”

A Comparative Study of Enhanced Recovery After Surgery (ERAS) Program and None-ERAS Traditional Care in Elderly Patients Undergoing Lumbar Arthrodesis

“…Although the compliance of early ambulation was only 70% in our study, the overall time until ambulation postoperatively was greatly shortened. Previous studies have shown that early ambulation is associated with decreased morbidity and adverse events after elective lumbar spine surgery [40]. However, preoperative deterioration of motor function, endurance and coordination makes early ambulation more di cult.…”

“…However, preoperative deterioration of motor function, endurance and coordination makes early ambulation more di cult. And early ambulation is often accompanied by orthostatic intolerance, such as dizziness and nausea, which increases the risk of aspiration and fall [40,41]. Therefore, for elderly patients, early ambulation should be encouraged rather than enforced, and should be accompanied by the presence of professional caregivers and patient con rmation of no obvious discomfort after sitting up.…”