Prehabilitation Improves Surgical Outcomes in Older Adults Undergoing Spinal Fusion: Study
China: Researchers have found in a randomized clinical trial that a multimodal prehabilitation program administered before spinal fusion surgery in older adults was associated with a lower risk of postoperative complications and a shorter hospital stay compared with standard care.
These findings suggest that optimizing patients' physical and functional status before surgery can improve immediate recovery outcomes. However, at 90-day follow-up, patients in the control group demonstrated better physical function, indicating that while prehabilitation may enhance short-term surgical recovery, its longer-term effects on functional outcomes require further investigation.
The findings were published in the Annals of Internal Medicine by Shuaikang Wang and colleagues from Xuanwu Hospital of Capital Medical University and the National Clinical Research Center for Geriatric Diseases.
Older adults undergoing spinal fusion surgery often have reduced physiological reserve and are particularly vulnerable to postoperative complications. Prehabilitation, which aims to improve a patient's physical, nutritional, and psychological status before surgery, has emerged as a potential strategy to enhance recovery, but evidence in elderly spinal surgery patients has remained limited.
Researchers conducted a multicenter randomized trial across three tertiary hospitals in China involving adults aged 75 years or older undergoing elective spinal fusion surgery.
Participants were assigned to either a four-week multimodal prehabilitation program plus Enhanced Recovery After Surgery (PREERAS) or standard ERAS care alone. The prehabilitation program included supervised exercise, nutritional optimization, and psychological support. Of the 164 randomized patients, 159 were included in the final analysis. The primary outcome was the occurrence of any postoperative complication within 90 days of surgery.
Key findings from the study included:
- Postoperative complications occurred in 74.7% of patients in the PREERAS group compared with 91.2% in the ERAS-only group.
- Multimodal prehabilitation was associated with a 20% relative reduction in the risk of postoperative complications.
- The absolute reduction in complication rates was 18 percentage points.
- Patients who underwent prehabilitation also experienced shorter hospital stays than those receiving standard care.
- Despite these early benefits, physical function at 90 days after surgery was better in the ERAS-only group.
The researchers suggested that optimizing physical fitness, nutrition, and psychological well-being before surgery may help older adults better withstand surgical stress and reduce postoperative complications.
Key limitations included the lack of blinding among participants and clinicians, as well as potential differences in healthcare systems and hospitalization practices that may affect the generalizability of the findings.
The authors concluded that multimodal prehabilitation can improve short-term postoperative outcomes in older adults undergoing spinal fusion surgery, but further research is needed to clarify its long-term effects on physical function and its feasibility in different healthcare settings.
Reference: https://doi.org/10.7326/ANNALS-25-05205
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