Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan.
Neurosurgery. 2020 Aug 1;87(2):320-328. doi: 10.1093/neuros/nyz501.
While consistently recommended, the significance of early ambulation after surgery has not been definitively studied.
To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery.
The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured.
A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0.
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 programs.
尽管一直被推荐，但术后早期活动的意义尚未得到明确研究。
确定术后第 0 天（术后第 1 天，POD#0）活动与腰椎手术后 90 天不良事件之间的关系。
密歇根州脊柱手术改进协作组（MSSIC）是一个前瞻性的脊柱手术患者多中心登记处。作为常规术后护理的一部分，患者要么在 POD#0 活动，要么不活动。测量了 90 天的住院时间（LOS）、尿潴留（UR）、尿路感染（UTI）、肠梗阻、再入院、手术部位感染（SSI）、肺栓塞/深静脉血栓形成（PE/DVT）和康复设施的处置等不良事件。
共分析了 23295 例腰椎手术患者。POD#0 活动与 LOS 缩短（相对 LOS 0.83，P<.001）、康复出院（优势比 [OR] 0.52，P<.001）、30 天（OR 0.85，P=.044）和 90 天（OR 0.86，P=.014）再入院、UR（OR 0.73，P=10）、UTI（OR 73，P=.001）和肠梗阻（OR 0.52，P<.001）相关。在单节段减压（4698 例）、多节段减压（4079 例）、单节段融合（4846 例）和多节段融合（4413 例）的亚组分析中，观察到 LOS、康复出院、再入院、UR、UTI 和肠梗阻的显著改善。对于在 POD#0 活动的患者，SSI 或 DVT/PE 的发生率没有变化。
POD#0 活动与腰椎手术后多个关键不良事件的风险显著降低相关。降低这些结果的发生率将与显著的成本节约相关。由于 POD#0 活动是大多数脊柱手术后患者术后护理中可改变的因素，因此应鼓励并纳入与脊柱相关的术后康复计划中。
