P112. The effect of preoperative rehabilitation on adult spinal deformity patient outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) is a debilitating disorder of the lumbar and thoracic spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Preoperative rehabilitation programs have recently 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 surgical ASD patient outcomes. <h3>PURPOSE</h3> Identify if preoperative rehabilitation influences patient outcomes following ASD-corrective surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 689 ASD Patients. <h3>OUTCOME MEASURES</h3> Preoperative rehabilitation, cognitive behavioral therapy, length of stay, readmission, ODI. <h3>METHODS</h3> ASD patients with baseline (BL) and 2-year (2Y) followup 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 [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 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 BL: severe neurological deficit (< 3/5), minimal ambulation or current depression/anxiety. Means comparison tests and multivariable logistic regression analysis controlling for age, CCI, ASA grade and invasiveness assessed differences between patient groups. <h3>RESULTS</h3> There were 183 patients that met inclusion criteria (52 prehab, 131 no prehab). The cohort was 50% female, mean age of 58.8 yrs and 6.9 levels fused and 159 (87.0%) undergoing an osteotomy. There was a significant difference in LOS for patients who had (3.9 days) and didn't have (6.2 days) prehab, p<.05. Multivariate regression showed that prehab was an independent predictor of a shorter LOS (OR .756 [CI .600-.954], p=.018). By 2Y, prehab patients had lower rates of readmissions (7.7% vs 16.0%) than no prehab patients, but not significantly different. Controlling for BL, prehab patients were more likely to report better ODI scores than no prehab patients at 2Y follow-up (OR .960 [CI .926-.996], p=.028). <h3>CONCLUSIONS</h3> Preoperative rehabilitation appears to be significantly associated with a shorter length of stay following adult spinal deformity-corrective surgery. Patients who had preoperative rehabilitation also had better reported clinical outcomes by 2 years postoperatively. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.