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STUDY DESIGN Retrospective comparative study. OBJECTIVE This study aimed to investigate factors associated with postoperative unfavorable ambulatory status following surgery for metastatic spinal tumors using a nationwide in-hospital database. SUMMARY OF BACKGROUND DATA Surgical treatment for metastatic spinal tumors can improve ambulatory status and quality of life (QOL). However, some patients fail to regain the ability to walk, thereby resulting in poor QOL. No large-scale study has previously evaluated factors associated with postoperative poor ambulatory status in this clinical context. METHODS The Diagnosis Procedure Combination database from 2018 to 2019 was used to extract data from patients who underwent surgical procedures for spinal metastasis. Postoperative unfavorable ambulatory status was defined as (1) non-ambulatory at discharge or (2) a decreased mobility score of the Barthel Index between admission and discharge. Multivariable logistic regression was used to evaluate factors associated with postoperative unfavorable ambulatory status while adjusting for confounders. RESULTS This study analyzed 1786 eligible patients. Of whom, 1061 (59%) patients were ambulatory on admission and 1249 (70%) on discharge. Postoperative unfavorable ambulatory status was observed in 597 (33%) patients, with a significantly lower rate of discharge to home (41%/81%, P<0.001) and a longer postoperative hospital stay (46.2 d/31.4 d, P<0.001). Multivariable regresssion analysis revealed male sex (odds ratio [OR]: 1.43, P=0.002), laminectomy without fusion (OR: 1.55, P=0.034), Charlson Comorbidity Index of ≥7 (OR: 1.37, P=0.014), and preoperative non-ambulatory status (OR: 6.61, P<0.001) as factors associated with postoperative unfavorable ambulatory status. CONCLUSION Our large-scale database analysis revealed that 33% of patients experienced unfavorable ambulatory status following spinal metastasis surgery. Laminectomy without fusion and preoperative non-ambulatory status were among several factors influencing the prospect of unfavorable ambulatory status following surgery. LEVEL OF EVIDENCE 3.