Early Ambulation After Lumbar Spine Surgery
Download Zakaria, Hesham.pptx (12.6 MB)
Resident PGY 5
Henry Ford Hospital
Introduction: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality improvement collaborative. Using the MSSIC database, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-day adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility.
Material and Methods: A total of 23295 lumbar surgery patients were analyzed. Multivariate logistic regression models were constructed, including variables on patient demographics, medical history, and surgical intensity. Matching was performed to account for unknown confounding variables.
Results: POD#0 ambulation was associated with decreased LOS (OR0.83, p<0.001), UR (OR0.73, p=0.008), UTI (OR0.52, p=0.001), ileus (OR0.52, p<0.001), 30-day (OR0.84, p=0.035) and 90-day (OR0.86, p=0.009) readmission, and rehab discharge (OR0.52, p<0.001) for all patients. POD#0 ambulation after single-level decompression (6244 patients) decreased LOS (OR0.72, p<0.001), UR (OR0.73, p=0.004), UTI (OR0.43, p=0.003), and rehab discharge (OR0.18, p<0.001). Ambulation after multi-level decompression (5526 patients) was associated with decreased LOS (OR0.73, p<0.001), UR (OR0.75, p=0.04), ileus (OR0.60, p=0.027), and rehab discharge (OR0.44, p<0.001). Ambulation after single-level fusion (5790 patients) decreased LOS (OR0.85 p<0.001), 30-day readmission (OR0.77, p=0.032) and rehab discharge (OR0.65, p=0.004). Ambulation after multi-level fusion (5735 patients) decreased LOS (OR0.88, p<0.001), UTI (OR0.60, p=0.003), ileus (OR0.51, p=0.02), 30-day readmission (OR0.77, p=0.032), and rehab discharge (OR0.59, p<0.001). No change in rate of or DVT/PE was observed for patients who ambulated POD#0.
Conclusion: POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient’s postoperative care following most spine surgery, it should be encouraged and incorporated into spine related enhanced recovery after surgery (ERAS) programs. My research will improve patient care by showing how early ambulation on POD#0 can decrease adverse events & costs and improve patient outcomes associated with lumbar spine surgery.
Learning Objectives: By the conclusion of this session, participants will be able to: 1) Identify common adverse events and their costs after lumbar spine surgery 2) How ambulation on the day of surgery is associated with decreased incidence of adverse events 3) The importance of early ambulation on improving outcomes and decreasing costs of lumbar spine surgery.
Zakaria, Hesham M.; Bazydlo, Michael; Schultz, Lonni R; Nerenz, David; Abdulhak, Muwaffak M; Chang, Victor; and Schwalb, Jason M., "Early Ambulation After Lumbar Spine Surgery" (2019). Quality Improvement. 16.