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Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis

Adogwa, Owoicho, MD, MPH; Elsamadicy, Aladine A., BE; Fialkoff, Jared, BS; Cheng, Joseph, MD, MS; Karikari, Isaac O., MD; Bagley, Carlos, MD§

doi: 10.1097/BRS.0000000000002189
SURGERY

Study Design. Ambispective cohort review.

Objective. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates.

Summary of Background Data. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications.

Methods. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. “Days of immobility” was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into “early ambulators” and “late ambulators”, respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators.

Results. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01).

Conclusion. Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes.

Level of Evidence: 3

Department of Neurosurgery, Rush University Medical Center, Chicago, IL

Department of Neurosurgery, Duke University Medical Center, Durham, NC

Department of Neurosurgery, Yale University, New Haven, CT

§Department of Neurosurgery, University of Texas South Western, Dallas, TX.

Address correspondence and reprint requests to Owoicho Adogwa, MD, MPH, Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison, Suite 855, Chicago IL, 60612; E-mail: owoicho.adogwa@gmail.com

Received 29 September, 2016

Revised 15 December, 2016

Accepted 17 January, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.