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Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?

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Abstract

Purpose

To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery.

Methods

Operative CD patients ≥ 18 years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab−). Differences in pre and post-op factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales.

Results

115 patients were included (age: 61 years, 70% female, BMI: 28 kg/m2). Of these patients, 57 (49%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI, and frailty. Surgically, Prehab+ were able to undergo longer procedures (p = 0.017) with equivalent EBL (p = 0.627), and shorter SICU stay (p < 0.001). Post-operatively, Prehab+ patients reported greater reduction in pain scores and greater improvement in quality of life metrics at both 1Y and 2Y than Prehab− patients (all p < 0.05). Prehab+ patients reported significantly less complications overall, as well as less need for reoperation (all p < 0.05).

Conclusion

Introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling patients to undergo longer surgeries with lessened risk of peri- and post-operative complications.

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Funding

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Authors and Affiliations

  1. Hoag Neurosciences Institute, Newport Beach, CA, USA

    Pawel P. Jankowski

  2. Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA

    Peter S. Tretiakov, Oluwatobi O. Onafowokan, Ankita Das, Bailey Imbo, Oscar Krol, Rachel Joujon-Roche, Tyler Williamson, Pooja Dave, Jamshaid Mir, Stephane Owusu-Sarpong & Peter G. Passias

Authors
  1. Pawel P. Jankowski
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  2. Peter S. Tretiakov
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  3. Oluwatobi O. Onafowokan
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  4. Ankita Das
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Contributions

Pawel P. Jankowski, Peter S. Tretiakov, Oluwatobi O. Onafowokan, Ankita Das, Bailey Imbo, Oscar Krol, Rachel Joujon-Roche, Tyler Williamson, Pooja Dave, Jamshaid Mir, Stephane Owusu-Sarpong, Peter G. Passias: Active involvement in drafting and critical revision of manuscript, Provided final approval of version to be published, Study Design, Data Acquisition, Analysis and interpretation of data.

Corresponding author

Correspondence to Peter G. Passias.

Ethics declarations

Conflict of interest

None to disclose. Disclosures unrelated to current work: Peter G Passias: Cerapedics: Other financial or material support. Cervical Scoliosis Research Society: Research support. Globus Medical: Paid presenter or speaker. Medtronic: Paid consultant. Royal Biologics: Paid consultant. Spine: Editorial or governing board. Spinevision: Other financial or material support. SpineWave: Paid consultant. Terumo: Paid consultant.

Ethical approval

Institutional review board approval was gained prior to commencement of the study.

Informed consent

Gained from all patients prior to enrolment in study.

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Jankowski, P.P., Tretiakov, P.S., Onafowokan, O.O. et al. Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes?. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00845-8

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