Ramifications of Delayed Ambulation Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Single Institutional Study

Introduction: The aim of this study was to identify risk factors for delayed ambulation and the ramifications of delayed ambulation on healthcare utilization in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: The medical records of 129 adolescent (10 – 18 years) patients diagnosed with AIS undergoing posterior spinal fusion at a major academic institution from 2013-2020 were reviewed. Patients were categorized based on days from surgery to ambulation: early (≤ 1 day), intermediate (2 days), or late (≥ 3 days). Patient demographics, comorbidities, spinal deformity characteristics, intraoperative variables, complications, length of stay (LOS), and unplanned readmission rate were assessed. multivariate logistic regression analysis was used to identify independent risk factors for delayed ambulation and extended LOS.

Results: Of the 129 patients were included in this study, 10.8% (n=14) were classified as Early ambulators, 41.9% (n=54) Intermediate ambulators, and 47.3% (n=61) were Late ambulators. Late ambulators were significantly younger than early and intermediate ambulators (p=0.010). The major and minor spinal curves were significantly worse among Late ambulators (p < 0.001). Fusion levels (p < 0.010), EBL (p=0.014), and the rate of RBC transfusions (p < 0.001) increased as time to ambulation increased. Transition time from IV to oral pain medications (p < 0.001) and total hospital length of stay (p < 0.001) was longer among Late ambulators. On multivariate analysis, significant predictors of delayed ambulation included major curve degree ≥70 degrees [aOR: 8.4,p=0.012] and procedure time [aOR: 1.6,p=0.035]. Delayed ambulation was significantly associated with extended LOS on univariate analysis [OR: 7.5,p < 0.010], but was not a significant predictor on multivariate analysis [aOR: 3.0,p=0.235].

Conclusion : Extent of major curve and operative time are independently associated with late ambulation following PSF for AIS. Additionally, delayed ambulation has implications on LOS and complications. Implementing ERAS protocols emphasizing early mobilization may optimize postoperative ambulation and decrease healthcare expenditures.