Preoperative Physical Therapy is Associated With Decreased Length of Stay and Improved Postoperative Mobility in Patients With Sarcopenia Undergoing Adult Spinal Deformity Surgery.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To determine the relationship between preoperative physical therapy (PT) and postoperative mobility, adverse events (AEs), and length of stay (LOS) among patients with low normalized total psoas area (NTPA) undergoing adult spinal deformity (ASD) surgery.

BACKGROUND

Sarcopenia, as defined by low NTPA, has been shown to predict poor perioperative outcomes of ASD surgery. However, there is limited evidence correlating the benefits of PT within the patient population with sarcopenic.

MATERIALS AND METHODS

NTPA was analyzed at the L3 and L4 mid-vertebral bodies on preoperative magnetic resonance imaging. Receiver operating characteristic curve analysis was used to determine sex-specific NTPA cutoff values for predicting perioperative AEs. Patients were categorized as having low NTPA if both L3 and L4 NTPA were below these cutoff values. Perioperative outcomes were compared between patients with low NTPA who underwent documented formal PT within 6 months before ASD surgery with those who did not.

RESULTS

A total of 103 patients (42 males, 61 females) met the criteria for low NTPA for inclusion in the study, of which 42 underwent preoperative PT and 61 did not. The preoperative PT group had a shorter LOS (111.2 ± 37.5 vs . 162.1 ± 97.0 h, P < 0.001), higher ambulation distances (feet) on postoperative day (POD) 1 (61.7 ± 50.3 vs . 26.1 ± 69.0, P < 0.001), POD 2 (113.2 ± 81.8 vs . 62.1 ± 73.1, P = 0.003), and POD 3 (126.0 ± 61.2 vs . 91.2 ± 72.6, P = 0.029), and lower rates of total AEs (31.0% vs . 54.1%, P = 0.003) when excluding anemia requiring transfusion. Multivariable analysis found preoperative PT to be the most significant predictor of decreased LOS (odds ratio: 0.32, P = 0.013).

CONCLUSION

Patients with sarcopenia may benefit from formal preoperative PT before undergoing ASD surgery to improve early postoperative mobility, decrease adverse eveents, and reduce length of stay.

LEVEL OF EVIDENCE

Level III.