Extubation-to-First Mobilisation Interval in Major Spine Surgery: A Prospective Study

Background Early mobilisation is a key component of Enhanced Recovery After Surgery (ERAS) protocols and has been associated with improved postoperative recovery following major spine surgery. However, limited prospective data exist regarding the impact of the interval between extubation and first mobilisation on postoperative outcomes. Objective This study aims to prospectively evaluate the extubation-to-first mobilisation interval in patients undergoing major spine surgery and assess its association with postoperative pain, analgesic requirements, complications, and hospital stay. Methods This prospective observational study was conducted at Stavya Spine Hospital and Research Institute, Ahmedabad. Adult patients undergoing planned major spine surgery, including multilevel fusion, instrumentation, and complex decompression procedures, were consecutively enrolled. The primary variable assessed was the interval (hours) between extubation and first out-of-bed mobilisation. Postoperative outcomes included serial Visual Analog Scale (VAS) pain scores, analgesic requirements, Oswestry Disability Index (ODI), complications, and duration of hospital stay. Results A total of 267 patients were included. The mean extubation-to-first mobilisation interval was 14.9 ± 9.3 hours. Among patients with documented mobilisation timing, 102 patients were mobilised within 6 hours, 96 within 24 hours, and 2 beyond 24 hours post-extubation. Earlier mobilisation was associated with lower postoperative pain scores. Patients mobilised within 6 hours demonstrated lower mean VAS scores at 6, 24, 48, and 72 hours compared to those mobilised at 24 hours. The mean discharge VAS and ODI scores were 3.0 and 18.2, respectively, with an average hospital stay of 4.3 ± 1.6 days. Higher analgesic requirements, including tramadol-containing combinations and rescue Butrum analgesia, were associated with relatively higher pain scores and delayed mobilisation. Earlier mobilisation was more commonly observed following minimally invasive lumbar procedures, whereas delayed mobilisation was associated with multilevel fusion procedures, greater blood loss, and longer operative duration. Conclusion The extubation-to-first mobilisation interval appears to be a simple and clinically meaningful parameter reflecting early postoperative recovery following major spine surgery. Earlier mobilisation was associated with lower postoperative pain scores and favourable recovery trends. Larger prospective multicentre studies with adjustment for potential confounders are required to determine whether earlier mobilisation independently influences postoperative outcomes.