TY - JOUR
T1 - Ambulation on postoperative day #0 is associated with decreased morbidity and adverse events after elective lumbar spine surgery
T2 - Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC)
AU - Zakaria, Hesham Mostafa
AU - Bazydlo, Michael
AU - Schultz, Lonni
AU - Abdulhak, Muwaffak
AU - Nerenz, David R.
AU - Chang, Victor
AU - Schwalb, Jason M.
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
KW - Adverse events
KW - Ambulation
KW - Elective lumbar spine surgery
KW - MSSIC
KW - Morbidity
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U2 - 10.1093/neuros/nyz501
DO - 10.1093/neuros/nyz501
M3 - Article
C2 - 31832659
AN - SCOPUS:85088495535
SN - 0148-396X
VL - 87
SP - 320
EP - 328
JO - Neurosurgery
JF - Neurosurgery
IS - 2
ER -