83 - Why didn’t you walk yesterday? Factors associated with slow mobilization after adult spinal deformity (ASD) surgery

Saturday, June 3, 2023

11:54 AM – 11:56 AM

Location: Salons 10-12

Co-Author(s)

GK

Gregory Kazarian, MD

Hospital for Special Surgery, United States
FL

Francis Lovecchio, MD

Fellow
Hospital for Special Surgery, United States
YJ

Yusef Jordan, MD

Hospital for Special Surgery, United States
DK

David Kim, BS

Hospital for Special Surgery, United States
BZ

Bo Zhang, MD

United States
JC

John Clohisy, MD

Hospital for Special Surgery, United States

Presenting Author (Person doing the Podium Present(s)

RM

Robert Merrill, MD

Hospital for Special Surgery, United States

Co-Author(s)

AP

Anthony Pajak, BS

Hospital for Special Surgery, United States
AK

Austin Kaidi, MD

Hospital for Special Surgery, United States
RK

Rachel Knopp, MPH

Assistant Research Manager
Hospital for Special Surgery
New York, New York, United States
JE

Jonathan Elysee

Lenox hill Hospital, Northwell Health, United States
HN

Hiroyuki Nakarai

Hospital for Special Surgery, United States
HK

Han Jo Kim, MD

Associate Professor
Hospital for Special Surgery
New York, NY, United States

Submitter(s)

HK

Han Jo Kim, MD

Associate Professor
Hospital for Special Surgery
New York, NY, United States

Co-Author(s)

JD

Jerry Du, MD

Hospital for Special Surgery, United States

Disclosure(s):

John Clohisy, MD: No financial relationships to disclose

Robert Merrill, MD: No financial relationships to disclose

Anthony Pajak, BS: No financial relationships to disclose

Hiroyuki Nakarai: No financial relationships to disclose

Introduction
Late mobilization after ASD surgery is linked to adverse outcomes, but predictors of late mobilization and its clinical impact are poorly understood.

Aims/Objectives
The objectives of this study is to identify risk factors for delayed ambulation following surgical correction for ASD, as well as possible adverse events associated with delayed ambulation.

Methods
One-hundred and ninety-one patients with ASD who underwent lumbar spine posterior-only fusion (≥5 levels, LIV pelvis) at one institution (2013-2019) were reviewed. Patients who ambulated with physical therapy (PT) on POD2 or later (LateAmb, n=49) were propensity matched 1:1 to patients who ambulated on POD0-1 (NmlAmb, n=49) based on the extent of fusion and surgical invasiveness score (ASD-S) (Table 1). All dural tears were repaired primarily and were permitted to work with PT on POD1 without restrictions. Pre-, intra-, and postoperative risk factors were compared. Regressions were used to identify risk factors for late ambulation.

Results
Of the patients who did not ambulate on POD0-1, 32% declined participation secondary to pain or dizziness/fatigue, while 68% were restricted from participation by PT/nursing due to weakness, inability to follow commands, nausea/dizziness, pain, or hypotension. When controlled for frailty, operative time, number of 3-column osteotomies, blood transfusions, and complications on POD0-2, intraoperative estimated blood loss (EBL) >2L (OR=5.57 [1.51-20.55], p=0.010) was associated with an increased risk of delayed ambulation, with a 1.25 times higher risk for every 250mL increase in EBL (p=0.014). Modified 5-Item Frailty Index (mFI-5) was also associated with delayed ambulation (OR=2.53 [1.14-5.63], p=0.023). LateAmb demonstrated a higher hospital LOS (LateAmb 6.17±2.6, NmlAmb 8.43±3.98, p< 0.001). While there were no differences in medical complications between the groups on POD0-2 (22.4% vs. 18.4%, p=0.803), the LateAmb group had a large but non-significant increase in medical complications on POD3+ (14.3% vs. 26.5%, p=0.210).

Conclusions
Blood loss has the largest impact on early postoperative recovery. EBL demonstrates a dose-response relationship with risk for delayed ambulation. Delayed ambulation increases LOS and likely has an impact on medical complications.