1. Early mobilization vs prolonged (>24hrs) bedrest for incidental durotomy

Abstract

<h3>BACKGROUND CONTEXT</h3> Incidence of unintended durotomy in thoracic and lumbar decompression procedures ranges from 3%-13%. An arbitrary length of flat bed rest is often prescribed as a tool to reduce cerebrospinal fluid (CSF) pressure on a compromised dural closure. Two popular thoughts are that flat bed rest >24 hours increases medical complications, but flat bed rest > 24 hours protects against CSF leaks/wound complications by reducing the hydrostatic pressure on dural repair. <h3>PURPOSE</h3> To assess whether flat bed rest >24 hours after an incidental durotomy is a risk factor for medical complications and results in longer hospital stay. We hypothesize that <24 hours of bed rest results in fewer medical complications and does not increase the rate of CSF leak/wound complications. <h3>STUDY DESIGN/SETTING</h3> Retrospective case cohort study. <h3>PATIENT SAMPLE</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures were reviewed from 2010-2020. <h3>OUTCOME MEASURES</h3> The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. <h3>METHODS</h3> Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures at Virginia Commonwealth University in Richmond, Virginia were reviewed from 2010-2020. This is an IRB approved study. The duration of bed rest, length of hospital stay and complications (pulmonary, gastrointestinal, urinary and wound) were recorded. The rates of complications were compared with regard to the duration of flat bed rest (no bed rest or less than 24hrs vs greater than 24hrs). <h3>RESULTS</h3> A total of 420 primarily repaired incidental durotomies were identified. Of these, 254 patients had bed rest ≤ 24 hours and 107 patients were at bed rest > 24 hours. The average length of stay for patients in bed rest ≤ 24 hours was 4.47 ± 3.64 days vs 7.24 ± 4.23 days for bed rest > 24 hours group (p = < 0.0001). Total medical complications and wound complications (8.66% vs 15.89%, P = 0.043) were increased in the prolonged bed rest group. There was a statistically significant increase in rate of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bedrest after an incidental durotomy. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, P = 0.86). The relative risk of a complication in the group with immediate mobilization was 50% less than the group with prolonged bed rest (RR = 0.5, 95% CI: 0.39-0.62, p = < 0.0001). <h3>CONCLUSIONS</h3> In this retrospective study, flat bed rest greater than 24hrs following incidental durotomy was associated with increased length of stay, increased rate of medical and wound complications. The rate of revision surgery was not higher in the durotomy patients who underwent immediate mobilization. Flat bed rest after an incidental durotomy may not be necessary and may result in higher costs and complications. This data can be helpful in planning enhanced recovery after surgery (ERAS) protocols. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.