Abstract
Early mobilisation is a cornerstone of Enhanced Recovery after Surgery (ERAS) and is encouraged following spinal procedures. However, evidence of its implementation is limited and there are no formal guidelines on optimal prescription. This narrative review aimed to evaluate the evidence for the effect of early mobilisation following elective spinal surgery on length of stay, postoperative complications, performance-based function and patient-reported outcomes. Four trials (five articles) that compared a specific protocol of early in-hospital mobilisation to no structured mobilisation or bed rest were selected for inclusion. Nine studies that investigated the implementation of a multimodal intervention that was inclusive of an early mobilisation protocol were also included. Results suggest that goal-directed early mobilisation, delivered using an evidence-based algorithm with a clear, procedure-specific inclusion and exclusion criteria, may reduce length of stay and complication rate. In addition, there is evidence to suggest improved performance-based and patient-reported outcomes when compared to bed rest following elective spinal surgery. Whilst this review reveals a lack of evidence to determine the exact details of which early mobilisation protocols are most effective, mobilisation on the day of surgery and ambulation from the first postoperative day is possible and should be the goal. Future work should aim to establish consensus-based, best practice guidelines on the optimal type and timing of mobilisation, and how this should be modified for different spinal procedures.
Highlights
Over the last twenty years, the significant growth and adoption of Enhanced Recovery afterSurgery (ERAS) or “fast-track” pathways represent a paradigm shift in how surgical care is delivered for a number of procedures [1]
(Table 2), and nine studies that compared the implementation of a multimodal intervention that was inclusive of an early mobilisation protocol [21,24,42,43,44,45,46,47,48] (Table 3) were included in the results synthesis
This review found that despite the growth and adoption of Enhanced Recovery after Surgery (ERAS) to spine surgery, the evidence base for early mobilisation remains limited across all procedures
Summary
Over the last twenty years, the significant growth and adoption of Enhanced Recovery afterSurgery (ERAS) or “fast-track” pathways represent a paradigm shift in how surgical care is delivered for a number of procedures [1]. The multimodal, multidisciplinary approach to the care of a patient comprises a combination of evidence-based interventions in the perioperative period that aim to reduce convalescence by reducing the stress of the operation to retain anabolic homeostasis [1]. This involves preparing the patient for surgery through assessment and education, ensuring they have the best possible management during their operation (including minimally invasive surgery, pain control and optimal fluid management) and expediting their postoperative recovery (for example, through early feeding and mobilisation) [2,3,4]. The traditional practice of bed rest following a surgical procedure has been associated with negative outcomes [8], such as a greater risk of thromboembolism, pneumonia, muscle wasting and physical deconditioning [9].
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