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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).

Authors
  • Zakaria, Hesham Mostafa1
  • Bazydlo, Michael2
  • Schultz, Lonni2
  • Abdulhak, Muwaffak1
  • Nerenz, David R1, 3
  • Chang, Victor1
  • Schwalb, Jason M1, 3
  • 1 Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
  • 2 Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan.
  • 3 Center for Health Policy and Health Services Research, Henry Ford Hospital, Detroit, Michigan.
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
320–328
Identifiers
DOI: 10.1093/neuros/nyz501
PMID: 31832659
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. 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. 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. 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. Copyright © 2019 by the Congress of Neurological Surgeons.

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