Ultra-early postoperative ambulation in spine surgery: a Michigan Spine Surgery Improvement Collaborative study

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Patient Recovery

Background:

• Early ambulation post-elective spine surgery is known to be beneficial.
• Limited data exists on the feasibility and advantages of ultra-early postoperative ambulation (within 4 hours).
• Current protocols often target 80% of patients ambulating within 8 hours.

Purpose of the Study:

• To compare the benefits of ultra-early ambulation (< 4 hours) versus early ambulation (4-8 hours) after elective spine surgery.
• To determine if ambulating within 4 hours post-surgery leads to greater positive outcomes.
• To evaluate complication rates, length of stay, and patient-reported outcomes.

Main Methods:

• Retrospective analysis of 21,725 patients from the Michigan Spine Surgery Improvement Collaborative database (Jan 2020 - May 2024).
• Patients divided into two groups: ambulation < 4 hours (ultra-early) and 4-8 hours postoperatively.
• Exclusion criteria included multi-level alterations, durotomy, or CSF leakage; multivariate analysis adjusted for confounders.

Main Results:

• The ultra-early ambulation group (< 4 hours) showed a significantly shorter hospital length of stay (0.47 days).
• Compared to the 4-8 hour group, ultra-early ambulation was associated with fewer complications (RR 1.14), lower readmission rates (RR 1.18), and better back pain improvement at 1 year.
• Patients ambulating ultra-early were less likely to be discharged to home.

Conclusions:

• Ultra-early ambulation (< 4 hours) following elective spine surgery is feasible.
• This approach demonstrates potential benefits, including a reduced risk of complications and lower readmission rates.
• Ultra-early ambulation may enhance overall patient outcomes in elective spine surgery.