Spine Fellow Department of Neurosurgery, Stanford Medicine, California, United States
Introduction: No current guidelines exist regarding the use of outpatient rehabilitation following lumbar fusion surgery. We aim to investigate the pattern and timing of postoperative outpatient rehabilitation initiation amongst this patient cohort in the U.S.
Methods: The MarketScan (Truven Health) inpatient, outpatient, and pharmaceutical claims database was used to identify patients undergoing lumbar fusion surgery in the US between 2008 and 2015. Patients were grouped into those with initiation of postoperative rehabilitation vs no rehabilitation. Patients with postoperative rehabilitation were further stratified by timing of rehabilitation initiation within 3 months after index surgery vs. after 3 months. Association between rehabilitation and postoperative high-frequency opioid use as well as 1-year reoperation rate was assessed using logistic regression analysis and their effect size was determined.
Results: Among 6033 patients undergoing lumbar fusion surgery, 1927 (32%) initiated postoperative rehabilitation within a mean of 81.5 days (SD 67.8) after surgery. Of those 1231 patients (64%) initiated rehabilitation within 3 months postoperative. Patient with postoperative rehabilitation showed a similar rate of reoperation (4.7% vs 4.0%) but increase high-frequent opioid use (25.5% vs 19.5%, p < 0.001) then patients without rehabilitation. After adjustment for confounders, patient with postoperative rehabilitation were as likely to experience reoperation but more likely to present with postoperative high-frequency opioid use (aOR 1.35, 95% CI 1.17–1.55, p < 0.001) despite statistical adjustment for possible covariables, such as US Region (Region South aOR 1.41, 95% CI 1.12–1.79, p = 0.003). Late start of rehabilitation within 3 months of surgery was an independent predictor of high-frequency opioid use (aOR 1.43, 95% CI 1.14–1.79, p = 0.002). 12-month total healthcare costs were higher in patients with initiation of postoperative rehabilitation (53900$ ± 44354$ vs 45614.9$ ± 41650$, p < 0.001).
Conclusion : Rehabilitation was associated with an increase in high-frequency opioid use and healthcare cost. This study does not support the use of outpatient postoperative rehabilitation to lower reoperation rates and postoperative pain in lumbar fusion surgery.
How to Improve Patient Care: This study questions the general use of outpatient postoperative rehabilitation after lumbar fusion surgery and should encourage a more targeted treatment as well as further research into this field.
