Why Didn't You Walk Yesterday? Factors Associated With Slow Early Recovery After Adult Spinal Deformity Surgery

Area of Science:

• Spine surgery
• Orthopedics
• Patient outcomes

Background:

• Delayed ambulation is a concern following adult spinal deformity (ASD) surgery.
• Identifying risk factors and complications associated with delayed ambulation is crucial for improving patient care.

Purpose of the Study:

• To identify risk factors for delayed ambulation after posterior-only fusion for ASD.
• To determine complications associated with delayed ambulation in these patients.

Main Methods:

• Retrospective case-control study of 191 patients undergoing posterior-only fusion (≥5 levels, LIV pelvis).
• Patients were propensity-matched (1:1) based on fusion extent and surgical invasiveness score.
• Logistic regression analysis was used to identify risk factors for delayed ambulation (POD2 or later).

Main Results:

• Intraoperative estimated blood loss (EBL) >2L was independently associated with increased risk of delayed ambulation (OR = 5.57).
• A higher Modified 5-Item Frailty Index (mFI-5) was also independently associated with delayed ambulation (OR = 2.53).
• The delayed ambulation group had a significantly longer hospital length of stay (LOS).

Conclusions:

• Estimated blood loss shows a dose-response relationship with the risk of delayed ambulation.
• Delayed ambulation increases hospital LOS and may impact medical complications after ASD surgery.