The Effect of Preoperative Rehabilitation on Adult Spinal Deformity Patient Outcomes, Patient Recovery Kinetics, and Cost Effectiveness

Introduction: The purpose of this study was to identify the effect of preoperative rehabilitation on surgical ASD patient outcomes.

Methods: ASD patients with baseline (BL) and two-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into 2 groups: those who had preoperative rehabilitation (Prehab+) and those who did not (Prehab-). Prehab consisted of physical and mental components. Patients were excluded if they presented with any of the following at BL: severe neurological deficit ( < 3/5), minimal ambulation, or current depression/anxiety. Normalized HRQL scores at BL and follow-up intervals (6W, 1Y, 2Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost per QALY at 2Y were calculated via pearldiver. Means comparison tests and Multivariable regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.

Results: 464 patients met inclusion criteria (Prehab+:186 and Prehab-: 278) Prehab+ patients were older, had a higher CCI, and a higher BMI (all;p < 0.001).
Prehab+ patients had shorter LOS(7.0 ± 4.3 vs. 7.8 ± 4.1 days;p=0.045) and lower EBL(1177.0 ml vs. 1532.8 ml;p=0.006), lower transfusion rates (54% vs. 67%;p=0.003), more patients discharged within three days(13.0%vs.3.2%;p < 0.001)lower SICU admission rate(51.6% vs. 65.4%;p=0.003).
Prehab+ patients had a lower rate of overall complications (69.9%vs.78.4%;p=0.038), medical complications (16.7% vs. 24.8%;p=0.036), and reoperation rate (18.3% vs. 33.5%;p < 0.001). Multivariate analysis confirmed that Prehab+ patients had a lower risk of complications (OR:0.6;95%CI:0.42–0.87;p=0.035) and reoperation (OR:0.38;95%CI:0.24–0.61;p < 0.001). Prehab+ patients also demonstrated superior HRQL outcomes at 2Y, including higher rates of achieving the MCID in PCS at 6W (42.9% vs. 15.1%;p=0.003) and SRS-22r total score at 1Y(OR:3.11;95%CI:1.16–8.4;p=0.024). Cost-effectiveness analysis revealed that Prehab+ patients had a lower cost per QALY at 2Y($14,463 vs. $45,515;p < 0.05).

Conclusion : Preoperative rehabilitation appears to be significantly associated with a shorter length of stay, better reported clinical outcomes, greater utility gained, costs by procedure and cost effectiveness at two-year follow-up following adult spinal deformity surgery