Spine Surgeon NYU School of Medicine New Canaan, Connecticut, United States
Introduction: Adult Spinal Deformity (ASD) is a debilitating disease of the upper spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Little is known about the effect of preoperative rehabilitation on patient outcomes and costs of the procedure.
Methods: ASD patients with baseline (BL) and two-year (2Y) follow-up and available preoperative rehabilitation data were included. Patients were dived on whether or not they completed a preoperative rehabilitation assignment (Prehab) or not (no Prehab). 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 was calculated using the PearlDiver database. This data is representative of national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per Quality-Adjusted Life Year (QALY) at 2Y were calculated. Binary regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.
Results: 100 patients were included (36 Prehab, 64 no Prehab). Normalized HRQLs determined Prehab patients to exhibit better ODI than no Prehab patients at 2Y follow-up, P<.05. Multivariate analysis confirmed Prehab patients more likely to improve in ODI (OR .055 [CI .006-.476], p=.008) at 2Y. However, Prehab and no Prehab patients exhibited similar ODI IHS recovery rates from BL to 2Y, P<.05. Total cost for Prehab patients was $59,272 compared to $72,878 for not Prehab, P<.05. Utility Gained at 2Y was 0.168 for Prehab and 0.121 for not Prehab, P<.05. This translated to QALY gained at 2Y of 5.09 for Prehab and 4.21 for not Prehab, P>.05. Cost effectiveness was determined via cost per QALY: Prehab = $14,463 and not Prehab = $45,515, P<.05.
Conclusion : Patients who had a preoperative rehabilitation prior to corrective surgery were in a better state of postoperative back disability at two year follow-up. While both patient cohorts had improvement following surgery, patients with preoperative rehabilitation had greater utility gained at two year follow-up. Costs by procedure and cost effectiveness were better for patients who had preoperative rehabilitation.
