Research Fellow NYU Langone Medical Center Paterson, NJ, US
Introduction: Adult Spinal Deformity (ASD) is a debilitating disease of the upper spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Little is known about the effect of preoperative rehabilitation on patient outcomes and costs of the procedure.
Methods: Patients were divided on preoperative rehabilitation assignment (Prehab) or not (no Prehab). Normalized HRQL at BL and follow-up were generated. Normalized HRQLs plotted and AUC calculated, generating one number describing recovery (Integrated Health State [IHS]). Cost calculated using PearlDiver, representative of national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per Quality-Adjusted Life Year (QALY) at 2Y were calculated. Binary regression analysis assessed patient reported outcomes and cost.
Results: 100 included (36 Prehab, 64 no Prehab). Age (59.2 vs 56.2), gender (F: 58% vs 45%), body mass index (32.9 vs 31.4), and Charlson Comorbidity Index (3.8 vs 3.9) were similar between groups (P > .05). Normalized HRQLs determined Prehab to exhibit better ODI than no Prehab at 2Y follow-up, P < .05. Multivariate analysis confirmed Prehab more likely to improve in ODI (OR .055 [CI .006-.476], p=.008) at 2Y. Prehab and no Prehab exhibited similar ODI IHS recovery rates from BL to 2Y, P < .05. Total cost for Prehab was $59,272 compared to $72,878 not Prehab, P < .05. Utility Gained at 2Y was 0.168 Prehab and 0.121 not Prehab, P < .05. This translated to QALY gained at 2Y of 5.09 for Prehab and 4.21 for not Prehab, P>.05. Cost effectiveness was determined via cost per QALY: Prehab = $14,463 and not Prehab = $45,515, P < .05.
Conclusion : Patients with preoperative rehabilitation had postoperative back disability at two years with greater utility gained. Costs by procedure and cost effectiveness were better for patients who had preoperative rehabilitation.