title: Prolonged bed rest as adjuvant therapy after complex reconstructive spine surgery.
abstract: BACKGROUND
  The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient's physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial.
  
  
  OBJECTIVE
  We evaluated the efficacy of prolonged bed rest after complex spine surgery to determine (1) patient characteristics that led to prescribing bed rest, (2) clinical and radiographic outcomes, (3) complications, and (4) estimated direct costs.
  
  
  METHODS
  We retrospectively reviewed all 11 patients (median age, 50 years) who underwent complex spine surgery followed by prolonged bed rest between 2005 and 2010. All patients were deemed at high risk for developing pseudarthrosis or instrumentation failure without postoperative bed rest. One patient died of complications related to pulmonary tuberculosis at 4 months. The patients averaged 3 months of bed rest. Minimum followup was 24 months (median, 30 months; range, 4-52 months).
  
  
  RESULTS
  All patients had (1) tenuous or limited fixation after correction of severe deformity, (2) previously failed spine reconstruction after early mobilization, or (3) limited treatment options if failure occurred again. No patient experienced pseudarthrosis, failure of instrumentation, thromboembolic disease, pressure ulcers, or pneumonia. One patient had a delayed union and one developed late urosepsis. The median cost of skilled nursing facilities during the period of bed rest was $16,702, while the median cost of home health nursing was $5712.
  
  
  CONCLUSIONS
  For patients with contraindications to early postoperative mobilization, prolonged bed rest may be useful to minimize the risk of complications that can occur with mobilization.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, 6700 West Loop South, Suite 110, Bellaire, TX 77041, USA. rexmarco@gmail.com
authors.forename: Rex A W
authors.initials: RA
authors.lastname: Marco
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Stuckey
authors.forename: Stephanie P
authors.initials: SP
authors.lastname: Holloway
mesh_terms: D000328:Adult; D000368:Aged; D001510:Bed Rest / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures; D010147:Pain Measurement; D011182:Postoperative Care; D011859:Radiography; D012086:Reoperation; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*