Director of Spinal Deformities Program Hoag Spine Institute Irvine, United States
Disclosure(s):
Jamshaid M. Mir, MD: No financial relationships to disclose
Introduction: MIS spine surgery techniques were developed to mitigate complications associated with open procedures while achieving functional outcomes. More recently, preoperative rehabilitation programs have been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on MIS spine surgery patient outcomes.
Methods: MIS patients with BL and 2Y follow-up were included. 2 groups: those who had preoperative rehabilitation [Prehab] and those who did not [no Prehab]. Prehab consisted of physical and mental components. Physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with post-op protocols, including gait and balance training. Patients were referred for cognitive behavioral therapy for 2 weeks to prepare. Patients were excluded if they presented at BL: severe neurological deficit ( < 3/5), minimal ambulation, or current depression/anxiety. Means comparison tests and regression analysis assessed differences between patient groups. CIT determined thresholds for continuous variables.
Results: 216 met inclusion (76 Prehab, 140 no Prehab). majority were male (97, 44.9%), mean age of 55.17 yrs and 2.3 levels fused and 28 (13.0%) undergoing 3-CO. There was a significant difference in LOS for patients who had (3.6 days) and didn’t have (5.3 days) Prehab, p < .05. Multivariate regression showed that Prehab was an independent predictor of a shorter LOS (OR .686 [CI .484-.972], p=.034). CIT analysis determined Prehab patients were 85.0% less likely to have a LOS greater than 2.0 days (OR .015 [CI .001-.258], p=.004). By 2Y, Prehab patients had lower rates of readmissions (6.7% vs 20.0%) and reoperations (4.0% vs 15.3%) than no Prehab patients, both p < .05.
Conclusion : Preoperative rehabilitation appears to be independently associated with a shorter length of stay following minimally invasive spine surgery. Patients who had preoperative rehabilitation also had lower rates of readmissions and reoperations by two-years postoperatively.
