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

Previous studies have demonstrated the benefit of early ambulation in patients who have undergone elective spine surgery. However, there are limited data on how early patients can feasibly move about in the postoperative period and whether there is further benefit in an ultra-early postoperative ambulation time frame. Current Michigan protocols aim for 80% of all patients ambulating within 8 hours of surgery end time. The goal of this retrospective study was to determine whether patients who ambulate within 4 hours of surgery have any greater benefit than those who ambulate 4-8 hours after surgery.

The Michigan Spine Surgery Improvement Collaborative database was queried for patients who had undergone elective spine surgery between January 2020 and May 2024. Patients were categorized into two groups based on the time to ambulation: < 4 hours postoperatively (ultra-early) and 4-8 hours postoperatively. Patients who had 4 or more levels altered, a durotomy, or CSF leakage were excluded from analysis. Primary outcomes were the presence of any complication and hospital length of stay. Secondary outcomes included patient-reported outcomes. A multivariate analysis was conducted to adjust for potential confounders.

A total of 21,725 patients were included in the study. Compared to the ultra-early cohort, the patients who ambulated 4-8 hours postoperatively were more likely to have complications (RR 1.14, 95% CI 1.04-1.26, p = 0.005), more likely to be readmitted after surgery (RR 1.18, 95% CI 1.03-1.35, p = 0.020), less likely to be discharged to home (RR 0.99, 95% CI 0.98-1.00, p = 0.005), and less likely to reach a minimal clinically important difference in back pain 1 year after surgery (RR 0.96, 95% CI 0.93-0.99, p = 0.022). The ultra-early ambulation cohort had a 0.47-day shorter length of stay (95% CI 0.34-0.6, p < 0.001) relative to the 4- to 8-hour cohort.

Ambulating patients in an ultra-early manner, that is, < 4 hours after spine surgery, is feasible and demonstrates a potential benefit in the outcomes of elective spine surgery. The benefits appear to be a lower risk of complications and lower likelihood of readmission.