Factors Associated with the Early Ambulation After Elective Lumbar Spinal Surgery: A Retrospective Cohort Study

Background: Early ambulation (EA), mobilizing within 24 h, is a cornerstone of recovery after lumbar spine surgery. Clinical evidence suggests that EA is strongly associated with superior postoperative outcomes, including accelerated functional recovery, reduced complications, and a significantly shorter length of hospital stay. Despite these benefits, there remains a critical gap in the literature regarding the specific patient and surgical factors that influence a patient’s ability to achieve early mobilization. Objective: To identify factors associated with EA and assess its relationship with postoperative recovery after elective lumbar spinal fusion. Methods: A retrospective cohort study was conducted at Phichit Provincial Hospital between 2017 and 2024. Demographic, anesthesia, and surgical data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent factors associated with EA. Results: Of 581 patients, 332 were in the EA group (57.2%), and 249 (42.8%) were in the delayed ambulation (DA) group. Independent factors associated with EA included American Society of Anesthesiologists (ASA) class I–II (OR 1.60, 95% CI 1.05–2.43, p = 0.027), anesthetic time < 200 min (OR 2.04, 95% CI 1.25–3.35, p = 0.005), and intravenous parecoxib administration (OR 3.45, 95% CI 2.34–5.18, p < 0.001). The EA group demonstrated significantly lower complication rates (3.9% vs. 20.4%, p < 0.001), shorter hospital stays (7 [IQR 6–9] vs. 9 [IQR 8–12] days, p < 0.001), and reduced total hospitalization costs ($1958 [IQR $933–$2966] vs. $2815 [IQR $1019–$3555], <0.001). No significant difference in 30-day readmission rates was observed. Conclusions: EA after elective lumbar spinal fusion was associated with better postoperative recovery. Factors independently associated with EA included lower ASA class, shorter anesthetic duration, and postoperative intravenous parecoxib use.