Comparison of Restricted Versus Liberal Postsurgical Ambulation Protocols on Outcomes After Lumbar Fusion Surgery.

Study design: Retrospective cohort study.

Objective: The objective of this study was to explore the impact of different hospital-based ambulation protocols on mobility and surgical outcomes after lumbar fusion surgery.

Summary of background data: Previous research has highlighted the value of early ambulation after surgery; still some hospitals choose to adopt a more conservative ambulation approach due to concern for patient safety.

Methods: Adult patients ≥18 years of age who underwent primary posterior lumbar decompression and fusion (PLDF) surgery at a hospital with restricted ambulation and a hospital with a liberal ambulation protocol within the same health system from 2021 to 2022 were identified and matched based on patient demographic characteristics. Surgical outcomes included inpatient complications, length of stay, readmissions, reoperations, and discharge disposition. Mobility outcomes included Activity Measure for Post-Acute Care (AM-PAC) daily activity score, post-therapy session pain rating, and gait trial distance from the first inpatient physical therapy session.

Results: Patients within the liberal ambulation protocol cohort had shorter hospital stays ( P <0.001) and were less likely to require reoperation within 1 year of surgery ( P =0.013). Patients within the restricted ambulation protocol were more likely to experience a complication ( P =0.005) and were less likely to be discharged home after surgery ( P =0.020). Patients at the liberal ambulation hospital had higher AM-PAC basic mobility scores ( P <0.001) and achieved further gait distances ( P <0.001). On multivariable regression analysis, a further gait distance at the first inpatient PT session was a significant predictor of decreased odds of inpatient complications ( P =0.010), decreased length of stay ( P =0.005), and increased odds of discharge to home ( P <0.001).

Conclusions: Liberal ambulation protocols are safe and effective postoperative management strategies after PLDF to decrease inpatient complications, length of stay and discharge to a rehabilitation facility. These findings highlight the role that such protocols can play in helping patients to achieve early mobilization and favorable short-term outcomes.