Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA.
Neurosurgery. 2022 Sep 1;91(3):505-512. doi: 10.1227/neu.0000000000002032. Epub 2022 May 17.
Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery.
To investigate whether ambulation less than 8 hours after elective spine surgery is associated with improved outcome.
The Michigan Spine Surgery Improvement Collaborative database was queried to track all elective cervical and lumbar spine surgery between July 2018 and April 2021. In total, 7647 cervical and 17 616 lumbar cases were divided into 3 cohorts based on time to ambulate after surgery: (1) <8 hours, (2) 8 to 24 hours, and (3) >24 hours.
For cervical cases, patients who ambulated 8 to 24 hours (adjusted odds ratio [aOR] 1.38; 95% CI 1.11-1.70; P = .003) and >24 hours (aOR 2.20; 95% CI 1.20-4.03; P = .011) after surgery had higher complication rate than those who ambulated within 8 hours of surgery. Similar findings were noted for lumbar cases with patients who ambulated 8 to 24 hours (aOR 1.31; 95% CI 1.12-1.54; P < .001) and >24 hours (aOR 1.96; 95% CI 1.50-2.56; P < .001) after surgery having significantly higher complication rate than those ambulated <8 hours after surgery. Analysis of secondary outcomes for cervical cases demonstrated that <8-hour ambulation was associated with home discharge, shorter hospital stay, lower 90-day readmission, and lower urinary retention rate. For lumbar cases, <8-hour ambulation was associated with shorter hospital stay, satisfaction with surgery, lower 30-day readmission, home discharge, and lower urinary retention rate.
Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.
早期活动被认为是手术后增强康复协议的关键因素。
研究择期脊柱手术后 8 小时内下床活动是否与改善结果相关。
密歇根脊柱手术改进合作数据库被用来跟踪 2018 年 7 月至 2021 年 4 月之间所有择期颈椎和腰椎手术。总共纳入了 7647 例颈椎和 17616 例腰椎病例，根据手术后下床活动的时间分为 3 组：（1）<8 小时，（2）8-24 小时，（3）>24 小时。
对于颈椎病例，与 8 小时内下床活动的患者相比，8-24 小时（校正优势比 [aOR] 1.38；95%置信区间 [CI] 1.11-1.70；P =.003）和>24 小时（aOR 2.20；95% CI 1.20-4.03；P =.011）下床活动的患者并发症发生率更高。对于腰椎病例也有类似的发现，与 8 小时内下床活动的患者相比，8-24 小时（aOR 1.31；95% CI 1.12-1.54；P<.001）和>24 小时（aOR 1.96；95% CI 1.50-2.56；P<.001）下床活动的患者并发症发生率更高。颈椎病例的次要结局分析表明，<8 小时下床活动与家庭出院、住院时间缩短、90 天内再入院率降低和尿潴留率降低相关。对于腰椎病例，<8 小时下床活动与住院时间缩短、对手术的满意度、30 天内再入院率降低、家庭出院和尿潴留率降低相关。
择期颈椎和腰椎手术后 8 小时内下床活动与显著改善结果相关。
