P63. Assessing the effects of prehabilitation protocols on postoperative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

Abstract

BACKGROUND CONTEXT Previous studies have demonstrated that preoperative rehabilitation (prehab) may be beneficial in adult cervical deformity surgery. Though protocols vary widely, general overlap exists in terms of inclusion of mental and physical modalities in order to optimize patient outcomes. However, there remains a paucity of literature in regards to assessing outcomes in a controlled setting. PURPOSE To assess the effects of prehabilitation on peri- and postoperative outcomes in adult cervical deformity surgery. STUDY DESIGN/SETTING Retrospective review of prospective CD database. PATIENT SAMPLE A total of 290 CD patients. OUTCOME MEASURES Peri- and postoperative complication rates; medication usage; HRQLs. METHODS Operative CD patients 18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in prehabilitation protocols beginning in 2019, consisting of physical therapy, nutritional counseling and/or psychological counseling. Patients were stratified as having underwent prehabilitation (Prehab+), versus those who did not (Prehab-). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors and complication rates were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated via NDI mapped to SF6D using validated methods. RESULTS A total of 115 patients were included (56.37±8.90 years, 38% female, 29.84±6.19 kg/m2). Of these patients, 57 (49.6%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI and frailty. In terms of BL HRQLs, Prehab+ significantly lower mJOA scores (p=.047), though were equivalent in NDI and EQ5D scores (both p>.05). Baseline opioid usage was comparable prior to prehab enrollment (p=.093). Surgically, Prehab+ were able to undergo longer procedures (p=.017) with equivalent EBL (p=.627), and shorter SICU stay (p.05) and QALYs gained by 2Y (.43 vs .40, p>.05). CONCLUSIONS This study demonstrates that introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling them to undergo longer surgeries with lessened risk of peri- and postoperative complications. Though cost-effectiveness of such programs should be further assessed, prehabilitation should be considered for eligible patients to assist in optimizing recovery and reducing complications or reoperations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Previous studies have demonstrated that preoperative rehabilitation (prehab) may be beneficial in adult cervical deformity surgery. Though protocols vary widely, general overlap exists in terms of inclusion of mental and physical modalities in order to optimize patient outcomes. However, there remains a paucity of literature in regards to assessing outcomes in a controlled setting. To assess the effects of prehabilitation on peri- and postoperative outcomes in adult cervical deformity surgery. Retrospective review of prospective CD database. A total of 290 CD patients. Peri- and postoperative complication rates; medication usage; HRQLs. Operative CD patients 18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were stratified by enrollment in prehabilitation protocols beginning in 2019, consisting of physical therapy, nutritional counseling and/or psychological counseling. Patients were stratified as having underwent prehabilitation (Prehab+), versus those who did not (Prehab-). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors and complication rates were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated via NDI mapped to SF6D using validated methods. A total of 115 patients were included (56.37±8.90 years, 38% female, 29.84±6.19 kg/m2). Of these patients, 57 (49.6%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI and frailty. In terms of BL HRQLs, Prehab+ significantly lower mJOA scores (p=.047), though were equivalent in NDI and EQ5D scores (both p>.05). Baseline opioid usage was comparable prior to prehab enrollment (p=.093). Surgically, Prehab+ were able to undergo longer procedures (p=.017) with equivalent EBL (p=.627), and shorter SICU stay (p.05) and QALYs gained by 2Y (.43 vs .40, p>.05). This study demonstrates that introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling them to undergo longer surgeries with lessened risk of peri- and postoperative complications. Though cost-effectiveness of such programs should be further assessed, prehabilitation should be considered for eligible patients to assist in optimizing recovery and reducing complications or reoperations.