{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:20:36Z","timestamp":1777659636678,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This is a retrospective case-control study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objectives of this study are to identify (1) risk factors for delayed ambulation following adult spinal deformity (ASD) surgery and (2) complications associated with delayed ambulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One-hundred and ninety-one patients with ASD who underwent posterior-only fusion (\u22655 levels, LIV pelvis) were reviewed. Patients who ambulated with physical therapy (PT) on POD2 or later (LateAmb, n = 49) were propensity matched 1:1 to patients who ambulated on POD0-1 (NmlAmb, n = 49) based on the extent of fusion and surgical invasiveness score (ASD-S). Risk factors, as well as inpatient medical complications were compared. Logistic regressions were used to identify risk factors for late ambulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the patients who did not ambulate on POD0-1, 32% declined participation secondary to pain or dizziness\/fatigue, while 68% were restricted from participation by PT\/nursing due to fatigue, inability to follow commands, nausea\/dizziness, pain, or hypotension. Logistic regression showed that intraoperative estimated blood loss (EBL) &gt;2L (OR = 5.57 [1.51-20.55],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .010) was independently associated with an increased risk of delayed ambulation, with a 1.25 times higher risk for every 250\u00a0mL increase in EBL (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .014). Modified 5-Item Frailty Index (mFI-5) was also independently associated with delayed ambulation (OR = 2.53 [1.14-5.63],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .023). LateAmb demonstrated a higher hospital LOS (8.4 \u00b1 4.0 vs 6.2 \u00b1 2.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). The LateAmb group trended toward an increase in medical complications on POD3+ (14.3% vs 26.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .210).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EBL demonstrates a dose-response relationship with risk for delayed ambulation. Delayed ambulation increases LOS and may impact medical complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231197976","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T02:44:28Z","timestamp":1692845068000},"page":"534-539","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Why Didn\u2019t You Walk Yesterday? Factors Associated With Slow Early Recovery After Adult Spinal Deformity Surgery"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2726-2417","authenticated-orcid":false,"given":"Gregory S.","family":"Kazarian","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-1420","authenticated-orcid":false,"given":"Francis","family":"Lovecchio","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Merrill","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8309-0176","authenticated-orcid":false,"given":"Jerry","family":"Du","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusef","family":"Jordan","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Pajak","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Knopp","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Kim","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6170-5220","authenticated-orcid":false,"given":"Justin","family":"Samuel","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Elysee","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izzet","family":"Akosman","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4903-9697","authenticated-orcid":false,"given":"Pratyush","family":"Shahi","sequence":"additional","affiliation":[{"name":"Hospital for Special 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