AIM: This study aimed to investigate the influence of average real variability (ARV) parameters of blood pressure on the recovery following posterior fixation surgery for thoracolumbar vertebral fractures. METHODS: A retrospective analysis was conducted on 190 patients who underwent posterior fixation surgery for thoracolumbar vertebral fractures at Ningbo Medical Center Lihuili Hospital between January 2021 and December 2023. Patients were divided into two groups based on their postoperative recovery: the good recovery group (n = 140) and the poor recovery group (n = 50). Univariate and binary logistic regression analyses were performed to identify factors influencing postoperative recovery. Pearson correlation analysis was used to assess the relationships between ARV and other variables, while receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of ARV in postoperative recovery. RESULTS: No statistically significant differences were observed between the two groups in terms of age, body mass index (BMI), gender, place of residence, monthly family income, occupation, education level, surgery duration, intraoperative blood loss, fracture type, fracture location, or fracture stage (p > 0.05). However, significant differences were noted in complication rates, ARV levels, and self-efficacy scores (p < 0.05). Pearson linear correlation analysis revealed that ARV was positively correlated with the presence of complications (r = 0.151, p < 0.05). Binary logistic regression analysis identified complications, ARV, and self-efficacy as significant factors influencing postoperative recovery (p < 0.05). Patients were divided into four groups based on ARV quartiles: Group 1 (ARV < 0.79), Group 2 (0.79 ≤ ARV < 0.89), Group 3 (0.89 ≤ ARV < 0.98), and Group 4 (ARV ≥ 0.98). A statistically significant difference in complication rates was observed across the groups (p < 0.05). ROC analysis showed that the area under the curve (AUC) for ARV in predicting postoperative recovery was 0.724 (95% confidence interval (CI): 0.612–0.836, p < 0.001). CONCLUSIONS: ARV is a significant factor influencing recovery following posterior fixation surgery for thoracolumbar vertebral fractures. Higher ARV levels are associated with increased postoperative complications, leading to poorer recovery outcomes.