MSSIC study: For best results after spine surgery, get moving as soon as possible

A Blue Cross Blue Shield of Michigan initiative is helping people get back on their feet after spine surgery and back to normal, daily activities.

The idea of getting up and moving around less than eight hours after a back or neck surgery might seem unpleasant, even risky to many patients. Yet, a recent study published in Neurosurgery* shows that this movement is safe and associated with better outcomes after surgery.

The study comes from the Michigan Spine Surgery Improvement Collaborative,* or MSSIC, a Blue Cross-sponsored Collaborative Quality Initiative focused on improving spine surgery quality of care and outcomes in the state.

“MSSIC and the larger CQI community continue to engage both Michigan providers and patients in implementing statewide quality improvement activities that have a profound impact on people’s lives,” said Thomas Leyden, director of Blue Cross’ Value Partnerships program. “We are excited to see these notable improvements coming out of the spine surgery CQI that benefit all parties involved by getting surgical patients back on their feet expeditiously and on the road to recovery.”

The surgical community continues to advocate for ambulation — the act of mobilizing the body or walking — as a way to aid in the recovery process. Surgical teams have adopted guidelines for Enhanced Recovery After Surgery, or ERAS, that include mobilization within 24 hours after surgery.

Some surgical teams promote ambulation within six to eight hours after surgery. Yet, there has been little evidence to support this early ambulation as a universal practice after elective spine surgery.

Looking at the data

Participants in MSSIC realized they had a trove of data that they could analyze that may provide needed evidence. MSSIC is a collaboration among 185 neurosurgeons and orthopedic surgeons in 27 hospitals and three ambulatory surgery centers across Michigan. Participating hospitals contribute patient data to a central registry, resulting in a comprehensive set of data that includes cases performed in an array of different settings, with diverse patient demographics and geographic parameters.

The MSSIC database was used to track all elective cervical and lumbar spine surgeries between July 2018 and April 2021. In total, 7,647 cervical and 17,616 lumbar cases were divided into three cohorts based on time to ambulate after surgery:

1. Less than eight hours
2. Eight to 24 hours,
3. More than 24 hours

The hypothesis was that early ambulation, occurring less than eight hours after surgery, would be associated with better outcomes after surgery.

The results

Because the ability to ambulate within eight hours can depend on some patient or surgery characteristics — and isn’t advised in some cases — the analysis first excluded the “contraindicated” cases and then adjusted for other potential confounding factors. After that adjustment, the surgeons observed that patients who got up and moved within eight hours of surgery had much better outcomes. In comparison, those who walked after eight hours experienced more complications.

Ambulation less than eight hours after surgery was associated with the following outcomes:

• Shorter length of stay in the surgical facility
• Higher discharge to the patients’ homes rather than a rehabilitation facility
• Higher patient satisfaction
• Lower rates of readmission to the hospital within 30 days of the surgery
• Lower rates of urinary retention after surgery

The researchers found that there is minimal risk for elective spine surgery patients to have supervised ambulation within eight hours, and they recommend early ambulation be included in standard protocols for ERAS.

“Because the MSSIC data registry is so comprehensive, and because it includes data from such a wide variety of surgical centers statewide, it offers relevant, significant and representative information that can inform future practice,” said Faris Ahmad, M.D., medical director, Clinical Partnerships at Blue Cross.

More about MSSIC

MSSIC brings together orthopedic surgeons and neurosurgeons to study ways to improve spine surgery outcomes in Michigan. Participants aim to improve the quality of care of spine surgery, reduce surgical complications, improve patient functional outcomes, reduce costs and episodes of care, and reduce the need for repeat surgeries. For more information, go to mssic.org.*

Blue Cross and Blue Care Network provide support for MSSIC as part of the Value Partnerships program. To learn more about Value Partnerships, visit valuepartnerships.com.

*Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.