Ultra-Early Post-Operative Ambulation in Elective Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Introduction: The benefit of early ambulation in the post-operative period for patients undergoing elective spine surgery has been demonstrated in prior studies. However, there is limited data on how early patients can be ambulated in the post-operative period. Our current state-wide protocols mandate ambulation within 8 hours of surgery end time. The goal of this study is to evaluate whether patients ambulated within 4 hours of surgery have further benefit compared to 4-8 hours.

Methods: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried for patients who underwent elective lumbar spine surgery between January 2020 and May 2024. Patients were grouped in 2 groups based on time to ambulate: less than 4 hours postoperative and 4 to 8 hours postoperative. Primary outcomes were rate of complications, urinary retention, return to OR, readmission rates, length of stay, patient satisfaction, and opioid use. A multivariate analysis was conducted to adjust for potential confounders.

Results: A total of 21,725 patients were included in the study. Compared to the less than 4 hour cohort, patients ambulated 4-8 hours were more likely to have a complication (RR=1.14; CI:1.04-1.26, p = 0.005), more likely to have readmission after surgery (RR=1.18; CI:1.03-1.35, p=0.02) less likely to be discharged home (RR=0.99; CI 0.98- < 1.00, p = 0.005) and less likely to reach a minimal clinical important difference (MCID) in their back pain at 1-year post-operative (RR=0.96; CI 0.93-0.99, p=0.022).

Conclusion : Patients ambulated in an ultra-early manner at less than 4 hours postoperative may benefit from more favorable post-operative outcomes for elective lumbar spine surgery. This appears to be related to a lower risk of complication and less likely for readmission.