112. The effect of preoperative rehabilitation on minimally invasive spine surgery patient outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> Minimally invasive (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. <h3>PURPOSE</h3> Identify if preoperative rehabilitation influences patient outcomes following MIS spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 524 MIS patients. <h3>OUTCOME MEASURES</h3> Preoperative rehabilitation, perioperative complications, patient outcomes. <h3>METHODS</h3> MIS spine surgery patients with baseline (BL) and two-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into two groups: those who had preoperative rehabilitation [Prehab] and those who did not [no Prehab]. Prehab consisted of physical and mental components, ie, physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with a review of postop protocols to do at home, including gait and balance training. Patients were also referred for cognitive behavioral therapy for 2 weeks to prepare for the stress of surgery. Patients were excluded if they presented with any of the following at baseline: severe neurological deficit (< 3/5), minimal ambulation, or current depression/anxiety. Means comparison tests and logistic regression analysis controlling for age, CCI, ASA grade, and invasiveness assessed differences between patient groups. Conditional inference tree (CIT) analysis determined thresholds for continuous variables. <h3>RESULTS</h3> A total of 216 patients met inclusion criteria (76 Prehab, 140 no Prehab). The majority were male (97, 44.9%), mean age of 55.17 years, 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 2 years, 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. <h3>CONCLUSIONS</h3> 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. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.