Comparison of Restricted Versus Liberal Postsurgical Ambulation Protocols on Outcomes After Lumbar Fusion Surgery

Area of Science:

• Orthopedics
• Neurosurgery
• Physical Therapy

Background:

• Early ambulation post-surgery is beneficial, but some hospitals remain conservative due to safety concerns.
• Hospital-based ambulation protocols vary, impacting patient recovery after lumbar fusion.

Purpose of the Study:

• To compare the effects of liberal versus restricted hospital ambulation protocols on patient mobility and surgical outcomes following lumbar fusion.
• To evaluate the safety and efficacy of different ambulation strategies in the postoperative care of lumbar fusion patients.

Main Methods:

• Retrospective cohort study matching adult patients (≥18 years) who underwent primary posterior lumbar decompression and fusion (PLDF).
• Comparison between patients from hospitals with restricted and liberal ambulation protocols (2021-2022).
• Outcomes assessed included surgical results (complications, length of stay, readmissions, reoperations, discharge disposition) and mobility metrics (AM-PAC scores, pain, gait distance).

Main Results:

• Liberal ambulation was associated with shorter hospital stays (P<0.001) and fewer reoperations (P=0.013).
• Restricted ambulation led to higher complication rates (P=0.005) and lower rates of home discharge (P=0.020).
• Patients in liberal protocol hospitals showed improved mobility, including higher AM-PAC scores (P<0.001) and greater gait distances (P<0.001).

Conclusions:

• Liberal ambulation protocols are safe and effective for postoperative management after PLDF.
• These protocols decrease inpatient complications, shorten hospital stays, and reduce discharges to rehabilitation facilities.
• Early mobilization through liberal ambulation protocols promotes favorable short-term surgical outcomes.