A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

Nancy E Epstein, Nancy E Epstein

Abstract

Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS) has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the "pros" of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients.

Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other) in various subspecialties, and correlated these with patients' perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors) contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery), preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations.

Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection), along with the average LOS.

Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS.

Keywords: Decreased cost; early mobilization; length of stay; prehabilitation; reduced morbidity; rehabilitation; spinal surgery.

References

    1. Awad S, Carter S, Purkayastha S, Hakky S, Moorthy K, Cousins J, et al. Enhanced recovery after bariatric surgery (ERABS): Clinical outcomes from a tertiary referral bariatric centre. Obes Surg. 2013 In press.
    1. Babu R, Owens TR, Thomas S, Karikari IO, Grunch BH, Moreno JR, et al. Timing of tracheostomy after anterior cervical spine fixation. J Trauma Acute Care Surg. 2013;74:961–6.
    1. Bekelis K, Desai A, Bakhoum SF, Missios S. A predictive model of complications after spine surgery: The National Surgical Quality Improvement Program (NSQIP) 2005-2010. Spine J. 2013 In press.
    1. Buerba RA, Fu MC, Gruskay JA, Long WD, 3rd, Grauer JN. Obese class III patients at significantly greater risk of multiple complications after lumbar surgery: An analysis of 10,387 patients in the ACS-NSQIP database. Spine J. 2013 In press.
    1. Caminiti C, Meschi T, Braglia L, Diodati F, Iezzi E, Marcomini B, et al. Reducing unnecessary hospital days to improve quality of care through physician accountability: A cluster randomized trial. BMC Health Serv Res. 2013;13:14.
    1. de Kraker ME, Davey PG, Grundmann H BURDEN study group. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: Estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011;8:e1001104.
    1. Diefenbach C, Ialenti MN, Lonner BS, Kamerlink JR, Verma K, Errico TJ. Hospital cost analysis of neuromuscular scoliosis surgery. Bull Hosp Jt Dis (2013) 2013;71:272–7.
    1. Epstein NE, Schwall GS, Hood DC. The incidence and cost of devices explanted during single-level anterior diskectomy/fusions. Surg Neurol Int. 2011;2:23.
    1. Epstein NE, Schwall GS, Hood DC. Reducing the cost and frequency of explantations associated with single-level anterior diskectomy and fusion at a single institution through education. Spine (Phila Pa 1976) 2012;37:414–7.
    1. Freeman R, Maley K. Mobilization of intensive care cardiac surgery patients on mechanical circulatory support. Crit Care Nurs Q. 2013;36:73–88.
    1. Hughes BG, Jain VK, Brown T, Spurgin AL, Hartnett G, Keller J, et al. Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high-risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution. Head Neck. 2013;35:436–42.
    1. Kaminski PN, Forgiarini LA, Andrade CF. Early respiratory therapy reduces postoperative atelectasis in children undergoing lung resection. Respir Care. 2013;58:805–9.
    1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238–43.
    1. Nandyala SV, Marquez-Lara A, Fineberg SJ, Schmitt DR, Singh K. Comparison of perioperative outcomes and cost of spinal fusion for cervical trauma: Weekday versus weekend admissions. Spine (Phila Pa 1976) 2013;38:2178–83.
    1. Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H. Prehabilitation and early rehabilitation after spinal surgery: Randomized clinical trial. Clin Rehabil. 2010;24:137–48.
    1. Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J., 3rd Rapid mobilization decreases length-of-stay in joint replacement patients. Bull Hosp Jt Dis (2013) 2013;71:222–6.
    1. Walid MS, Zaytseva N. How does chronic endocrine disease affect cost in spine surgery? World Neurosurg. 2010;73:578–81.
    1. Wang D, Teddy PJ, Henderson NJ, Shine BS, Gardner BP. Mobilization of patients after spinal surgery for acute spinal cord injury. Spine (Phila Pa 1976) 2001;26:2278–82.
    1. Zhu F, Lee A, Chee YE. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2012;10:CD003587.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner