Barriers to Early Mobilization after Spine Surgery

Abstract

Introduction There has been increased interest in reducing a patient’s length of stay in the hospital. One of the critical factors towards a patient’s prolonged stay is delayed ambulation, which in turn leads to a higher risk of complications such as ileus, atelectasis, and urinary retention. The purpose of this pilot study is to identify barriers to in-hospital mobilization Methods Thirty patients undergoing 1-2 level lumbar fusion were identified and data on demographics, medical history and surgery were collected. The Mini-Mental Status Examination (MMSE) was administered while they were awaiting surgery, in the recovery room and during post-operative day one (POD-1). Whether they were mobilized on the first day after surgery or not and the reasons why there was a delay in ambulation were also collected. Results Of the 30 patients in this pilot study, only 9 ambulated on POD-1. There were no differences in age, sex, American Association of Anesthesiologists grade, body mass index, smoking status, operative time, estimated blood loss, recovery room stay or MMSE at any time point between patients who were mobilized and those who were not. The most common reason for not mobilizing was the lack of a floor bed (11), followed by a late surgery start (4) and being on complete bed rest (3). Other reasons included incomplete orders (1), no therapist available (1) and presence of neurologic deficit pre-op (1). Discussion Early patient mobilization is largely dependent on hospital administrative factors rather than patient characteristics or surgical parameters.