Comparison of Restricted versus Liberal Post-Surgical 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 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 2021-2022 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). Conclusion. 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.