Safety and efficacy of early functional rehabilitation in elderly patients after short-segment lumbar spinal fusion surgery

English Keywords:Short-segment lumbar spinal fusion surgery  Elderly  Early functional rehabilitation  Complications

English Abstract:

  【Abstract】 Objectives: To explore the safety and efficacy of early functional rehabilitation in elderly patients(aged 75 years and older) after short-segment lumbar spinal fusion surgery. Methods: A retrospective review was performed on the elderly patients underging one- or two-segment lumbar fusion surgery after sufficient preoperative assessment in our hospital between January 2018 and April 2021. Patients who underwent lumbar fusion surgery after July 2019 received early functional rehabilitation of bed rehabilitation exercises under the guidance of rehabilitation physicians right postoperative on the day of surgery and ambulation within 2 days after surgery, and they were included in the early functional rehabilitation group. Patients surgically operated before July 2019 received conventional rehabiliation measures of ambulation after removal of the drainage tube and autonomous function exercise, and they were included in the control group. Clinical data of patients were collected, including baseline data(age, gender, primary diagnosis, preoperative VAS score of leg and low back pain, ODI, comorbidities, surgical history, and history of tobacco and alcohol), surgery-related data(operative time, intraoperative blood loss, fused segment), and surgical outcomes(time of first ambulation, time of drainage tube removal, complications within 90 days after surgery, readmission rate, length of postoperative hospital stay, and use of additional opioids after surgery). Results: A total of 188 patients were enrolled, including 94 patients in the early functional rehabilitation group and 94 patients in the control group. The rates of lower limb venous valvular insufficiency and surgical history were higher in early functional rehabilitation group than in control group(46% vs 22%, P＜0.01; 72% vs 55%, P=0.02), and no significance differences were observed in other baseline data and surgery-related data between groups(P＞0.05). The time of the first ambulation and removal of drainage tube was earlier in early functional rehabilitation group than control group(1.8±0.9d vs 4.5±1.6d and 2.2±0.3d vs 3.6±0.3d, P＜0.01). The incidence of postoperative hypoproteinemia in the early functional rehabilitation group was lower than that in the control group(28% vs 43%, P=0.03). There was no significant difference in the incidence of other complications, the length of postoperative hospital stay(7.0±3.3d vs 8.7±4.3d, P=0.06), and the rate of readmission within 90 days(3% vs 7%, P=0.12). The rate of additional postoperative opioids use was lower in the early functional rehabilitation group than in the control group(12% vs 34%, P=0.00). Conclusions: Early functional rehabilitation in patients aged 75 and older undergoing one- or two-level lumbar fusion surgery did not increase the incidence of postoperative complications, short-term readmission rate, or length of stay, which also decreased the retention time of drainage tube, incidence of postoperative hypoproteinemia, and the use of additional opioids.