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

Introduction: Preoperative rehabilitation programs have recently been implemented to prepare patients for ASD surgery and to promote patient health. 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 Prehab+ and 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 AUC was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost was calculated using the PearlDiver database. Cost per QALY at 2Y were calculated. Means comparison tests and Multivariable regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.

Results: The study included consecutive 464 patients, with 186 Prehab+ and 278 Prehab-. Prehab+ patients were older, had a higher CCI, and a higher BMI (all;p < 0.001). Prehab+ patients had shorter LOS (7.0 vs. 7.8;p=0.045) and lower EBL (1177.0 vs. 1532.8ml;p=0.006), lower Transfusion rates (54% vs. 67%; p = 0.003), earlier discharged within POD3 (13.0% vs. 3.2%; p< 0.001), and lower SICU admission rates (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) and medical complications (16.7% vs. 24.8%;p=0.036). The reoperation rate was significantly reduced in the Prehab+ group (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 SF-36 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 ($14,463vs.$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 ASD surgery