Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis

Owoicho Adogwa, Aladine A. Elsamadicy, Jared Fialkoff, Joseph Cheng, Isaac O. Karikari, Carlos Bagley

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Study Design. Ambispective cohort review. Objective. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Summary of Background Data. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. Methods. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Results. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Conclusion. Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes.

Original languageEnglish (US)
Pages (from-to)1420-1425
Number of pages6
JournalSpine
Volume42
Issue number18
DOIs
StatePublished - Sep 15 2017

Fingerprint

Early Ambulation
Scoliosis
Length of Stay
Immobilization
Walking
Incidence

Keywords

  • adult degenerative scoliosis
  • ambulation
  • discharge location
  • early ambulation
  • elderly patients
  • functional outcomes
  • home
  • length of stay
  • Readmission

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis. / Adogwa, Owoicho; Elsamadicy, Aladine A.; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O.; Bagley, Carlos.

In: Spine, Vol. 42, No. 18, 15.09.2017, p. 1420-1425.

Research output: Contribution to journalArticle

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abstract = "Study Design. Ambispective cohort review. Objective. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Summary of Background Data. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. Methods. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. {"}Days of immobility{"} was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into {"}early ambulators{"} and {"}late ambulators{"}, respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Results. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30{\%} vs. 54{\%}, P = 0.06). The length of inhospital stay was 34{\%} shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2{\%} vs. 22.0{\%}, P = 0.01). Conclusion. Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes.",
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AU - Adogwa, Owoicho

AU - Elsamadicy, Aladine A.

AU - Fialkoff, Jared

AU - Cheng, Joseph

AU - Karikari, Isaac O.

AU - Bagley, Carlos

PY - 2017/9/15

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N2 - Study Design. Ambispective cohort review. Objective. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Summary of Background Data. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. Methods. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Results. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Conclusion. Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes.

AB - Study Design. Ambispective cohort review. Objective. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Summary of Background Data. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. Methods. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Results. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Conclusion. Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is associated with higher complication rates and inferior functional outcomes.

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KW - home

KW - length of stay

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