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Nassr A. CORR Insights®: Does A Hinged Operating Table Facilitate Sagittal Correction in Transforaminal Lumbar Interbody Fusion With Smith-Peterson Osteotomy? A Radiographic Analysis. Clin Orthop Relat Res 2024; 482:1071-1073. [PMID: 38165280 PMCID: PMC11124698 DOI: 10.1097/corr.0000000000002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Ahmad Nassr
- Professor of Orthopedic Surgery and Neurosurgery, Mayo Clinic School of Medicine, Rochester, MN, USA
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Reyes JL, Coury JR, Dionne A, Miller R, Katiyar P, Smul A, Bakarania P, Lombardi JM, Sardar ZM. Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility. Spine Deform 2024:10.1007/s43390-024-00893-0. [PMID: 38789728 DOI: 10.1007/s43390-024-00893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions. METHODS We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation. CONCLUSIONS This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.
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Affiliation(s)
- Justin L Reyes
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Josephine R Coury
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Alexandra Dionne
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Roy Miller
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Prerana Katiyar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Abigail Smul
- Conservative Care for Spine and Scoliosis/ Columbia University Irving Medical Center, New York, NY, USA
| | - Prachi Bakarania
- Conservative Care for Spine and Scoliosis/ Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M Lombardi
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
| | - Zeeshan M Sardar
- The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 5141 Broadway, 3 Field West, New York, NY, 10034, USA
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Kim JH, Chegal Y, Kim S, Park H, Kim YR, Kim S, Kim K, Lee CH, Kim CH, Chung CK. Healthcare burden changes by restricted physical activities in lumbar spinal stenosis and spondylolisthesis: a retrospective large cohort study during the COVID-19 pandemic. BMC Musculoskelet Disord 2024; 25:411. [PMID: 38783291 PMCID: PMC11118721 DOI: 10.1186/s12891-024-07332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period. METHODS We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient's diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables. RESULTS Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p < 0.001) after SoD, whereas a significant change was not observed in the SPL group (difference, -$19/month·patient; p = 0.160). CONCLUSION Restricted physical activity during the SoD period decreased the healthcare burden for patients with LSS or, conversely, it did not significantly affect patients with SPL. Under circumstances of physical inactivity, patients with LSS may underrate their symptoms, while maintaining an appropriate activity level may be beneficial for patients with SPL.
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Affiliation(s)
- Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Yebin Chegal
- Department of Statistics, Korea University, Seoul, South Korea
| | - Suhyun Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea
| | - Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Rak Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Sum Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea.
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, 03080, Republic of Korea
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Higginbotham DO, El-Othmani MM, Nham FH, Alsoof D, Diebo BG, McCarty SA, Daniels AH. Perioperative Nutritional, Functional, and Bone Health Optimization in Spine Surgery: A National Investigation of Spine Surgeons' Perceptions and Practices. J Am Acad Orthop Surg 2024:00124635-990000000-00995. [PMID: 38773840 DOI: 10.5435/jaaos-d-23-00582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION While perioperative nutritional, functional, and bone health status optimization in spine surgery is supported with ample evidence, the implementation and surgeon perception regarding such efforts in clinical practice remain largely unexplored. This study sought to assess the current perception of spine surgeons and implementation regarding the nutritional, functional status, and bone health perioperative optimization. METHODS An anonymous 30-question survey was distributed to orthopaedic spine fellowship and neurosurgery program directors identified through the North American Spine Society and American Association of Neurological Surgeons contact databases. RESULTS The questionnaire was completed by 51 surgeon survey respondents. Among those, 62% reported no current formal nutritional optimization protocols with 14% not recommending an optimization plan, despite only 10% doubting benefits of nutritional optimization. While 5% of respondents perceived functional status optimization as nonbeneficial, 68% of respondents reported no protocol in place and 46% noted a functional status assessment relying on patient dependency. Among the respondents, 85% routinely ordered DEXA scan if there was suspicion of osteoporosis and 85% usually rescheduled surgery if bone health optimization goals were not achieved while 6% reported being suspicious of benefit from such interventions. CONCLUSION While most responding spine surgeons believe in the benefit of perioperative nutritional and functional optimization, logistical and patient compliance challenges were noted as critical barriers toward optimization. Understanding surgeon perception and current practices may guide future efforts toward advancement of optimization protocols.
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Affiliation(s)
- Devan O Higginbotham
- From the Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI (Higginbotham, Nham, and McCarty), the Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY (El-Othmani), and the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI (Alsoof, Diebo, and Daniels)
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Fleurent-Grégoire C, Burgess N, McIsaac DI, Chevalier S, Fiore JF, Carli F, Levett D, Moore J, Grocott MP, Copeland R, Edbrooke L, Engel D, Testa GD, Denehy L, Gillis C. Towards a common definition of surgical prehabilitation: a scoping review of randomised trials. Br J Anaesth 2024:S0007-0912(24)00182-X. [PMID: 38677949 DOI: 10.1016/j.bja.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition. METHODS The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis. RESULTS We identified 76 prehabilitation trials of patients undergoing abdominal (n=26, 34%), orthopaedic (n=20, 26%), thoracic (n=14, 18%), cardiac (n=7, 9%), spinal (n=4, 5%), and other (n=5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n=42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery.' CONCLUSIONS A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada; Department of Medicine, McGill University, Montréal, QC, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, Montréal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield UK
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Department of Surgery, McGill University, Montréal, QC, Canada; Department of Anesthesia, McGill University, Montréal, QC, Canada.
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Fleurent-Grégoire C, Burgess N, Denehy L, Edbrooke L, Engel D, Testa GD, Fiore JF, McIsaac DI, Chevalier S, Moore J, Grocott MP, Copeland R, Levett D, Scheede-Bergdahl C, Gillis C. Outcomes reported in randomised trials of surgical prehabilitation: a scoping review. Br J Anaesth 2024:S0007-0912(24)00103-X. [PMID: 38570300 DOI: 10.1016/j.bja.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Heterogeneity of reported outcomes can impact the certainty of evidence for prehabilitation. The objective of this scoping review was to systematically map outcomes and assessment tools used in trials of surgical prehabilitation. METHODS MEDLINE, EMBASE, PsychInfo, Web of Science, CINAHL, and Cochrane were searched in February 2023. Randomised controlled trials of unimodal or multimodal prehabilitation interventions (nutrition, exercise, psychological support) lasting at least 7 days in adults undergoing elective surgery were included. Reported outcomes were classified according to the International Society for Pharmacoeconomics and Outcomes Research framework. RESULTS We included 76 trials, mostly focused on abdominal or orthopaedic surgeries. A total of 50 different outcomes were identified, measured using 184 outcome assessment tools. Observer-reported outcomes were collected in 86% of trials (n=65), with hospital length of stay being most common. Performance outcomes were reported in 80% of trials (n=61), most commonly as exercise capacity assessed by cardiopulmonary exercise testing. Clinician-reported outcomes were included in 78% (n=59) of trials and most frequently included postoperative complications with Clavien-Dindo classification. Patient-reported outcomes were reported in 76% (n=58) of trials, with health-related quality of life using the 36- or 12-Item Short Form Survey being most prevalent. Biomarker outcomes were reported in 16% of trials (n=12) most commonly using inflammatory markers assessed with C-reactive protein. CONCLUSIONS There is substantial heterogeneity in the reporting of outcomes and assessment tools across surgical prehabilitation trials. Identification of meaningful outcomes, and agreement on appropriate assessment tools, could inform the development of a prehabilitation core outcomes set to harmonise outcome reporting and facilitate meta-analyses.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill Research, Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada.
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Rhim HC, Schon JM, Xu R, Nolan D, Ahn J, Short K, Schon LC. Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255136. [PMID: 38812567 PMCID: PMC11135079 DOI: 10.1177/24730114241255136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M. Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Raylin Xu
- Harvard Medical School, Boston, MA, USA
| | - David Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, USA
- Sports Physical Therapy Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jiyong Ahn
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kelly Short
- Center for Restorative Therapies, Mercy Medical Center, Baltimore, MD, USA
| | - Lew C. Schon
- Director of Orthopaedic Innovation, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, New York University Langone Health, NY, USA
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Li S, Du J, Huang Y, Gao S, Zhao Z, Chang Z, Zhang X, He B. From hyperglycemia to intervertebral disc damage: exploring diabetic-induced disc degeneration. Front Immunol 2024; 15:1355503. [PMID: 38444852 PMCID: PMC10912372 DOI: 10.3389/fimmu.2024.1355503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
The incidence of lumbar disc herniation has gradually increased in recent years, and most patients have symptoms of low back pain and nerve compression, which brings a heavy burden to patients and society alike. Although the causes of disc herniation are complex, intervertebral disc degeneration (IDD) is considered to be the most common factor. The intervertebral disc (IVD) is composed of the upper and lower cartilage endplates, nucleus pulposus, and annulus fibrosus. Aging, abnormal mechanical stress load, and metabolic disorders can exacerbate the progression of IDD. Among them, high glucose and high-fat diets (HFD) can lead to fat accumulation, abnormal glucose metabolism, and inflammation, which are considered important factors affecting the homeostasis of IDD. Diabetes and advanced glycation end products (AGEs) accumulation- can lead to various adverse effects on the IVD, including cell senescence, apoptosis, pyroptosis, proliferation, and Extracellular matrix (ECM) degradation. While current research provides a fundamental basis for the treatment of high glucose-induced IDD patients. further exploration into the mechanisms of abnormal glucose metabolism affecting IDD and in the development of targeted drugs will provide the foundation for the effective treatment of these patients. We aimed to systematically review studies regarding the effects of hyperglycemia on the progress of IDD.
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Affiliation(s)
- Shuai Li
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Medical College, Yan’an University, Yan’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Jinpeng Du
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Yunfei Huang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Shenglong Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Medical College, Yan’an University, Yan’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Zhigang Zhao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Zhen Chang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - Xuefang Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
| | - BaoRong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Youyidong Road, Xi’an, Shaanxi, China
- Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an, Shaanxi, China
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9
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Lindbäck Y, Carlfjord S. Experiences from pre-surgery physiotherapy and thoughts about future exercise among patients with disc herniation or spinal stenosis: A qualitative study. Musculoskelet Sci Pract 2024; 69:102892. [PMID: 38070465 DOI: 10.1016/j.msksp.2023.102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Continuous exercising after a physiotherapy intervention for low back pain (LBP) is known to be crucial, but sustaining new habits may be challenging. AIM To describe patients' pre- and post-surgery experiences after a pre-surgery physiotherapy intervention, and their thoughts about future exercise and self-management. METHODS Individual semi-structured interviews at two time-points were analysed with content analysis. Patients randomised to pre-surgery physiotherapy in an RCT evaluating the intervention, who had participated in ≥12 sessions, were invited. Eighteen patients were interviewed 0-8 months after pre-surgery physiotherapy, and sixteen of those completed a second interview 3-14 months later. RESULTS Three categories emerged: 1) "Personal experiences from pre-surgery participation", described how participation was perceived as challenging and sometimes stressful, but wellness improved. Cooperation with the physiotherapist was considered crucial and gave confidence. 2) "Attitudes to exercise", described exercise as an action of prevention and rehabilitation that demands motivation. Exercise was perceived to be good for you, physically but also improving mental health and other systems. 3) "Future physical activity - individual responsibility", described the return to former activities and potential challenges for the future. New knowledge was perceived to have changed the prerequisites for exercise and increased security in every-day physical activities. CONCLUSION Pre-surgery physiotherapy may enhance self-management through increased confidence, improved knowledge about progression, and awareness about exercise for pain relief, producing a new mindset. Challenges for continuing exercise should be addressed during the intervention. The result can inform supportive strategies for patients to continue with self-management after LBP rehabilitation.
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Affiliation(s)
- Yvonne Lindbäck
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Siw Carlfjord
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Hutton D, Mohamed B, Mehmood K, Magro J, Shekhar H, Solth A, Pulhorn H, Bennett D, Okasha M. COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 37940114 DOI: 10.1055/a-2206-2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution. METHODS Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records. RESULTS In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (n = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%). CONCLUSION Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.
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Affiliation(s)
- Dana Hutton
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Belal Mohamed
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Khalid Mehmood
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - James Magro
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Himanshu Shekhar
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Heinke Pulhorn
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - David Bennett
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Mohamed Okasha
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
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Shahrestani S, Brown NJ, Yue JK, Tan LA. Developing Mixed-effects Models to Optimize Prediction of Postoperative Outcomes in a Modern Sample of Over 450,000 Patients Undergoing Elective Cervical Spine Fusion Surgery. Clin Spine Surg 2023; 36:E536-E544. [PMID: 37651572 DOI: 10.1097/bsd.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN A retrospective cohort. OBJECTIVE We utilize big data and modeling techniques to create optimized comorbidity indices for predicting postoperative outcomes following cervical spine fusion surgery. SUMMARY OF BACKGROUND DATA Cervical spine decompression and fusion surgery are commonly used to treat degenerative cervical spine pathologies. However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery. METHODS Using data from 2016 to 2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. Receiver operating characteristic curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 1-year readmission. RESULTS A total of 453,717 patients were eligible. Nonroutine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14±18,274.86 (top quartile: $26,775.80) and the mean length of stay was 2.7±4.4 days (top quartile: 4.7 d). There were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within 1 year postoperatively. Models using frailty+ECI as primary predictors consistently outperformed the ECI-only model with statistically significant P -values for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as frailty outperformed both ECI and frailty+ECI in cost ( P <0.0001 for all) and frailty+ECI performed as well as ECI alone in mortality ( P =0.10). CONCLUSIONS Our data suggest that frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine fusion surgery. These models may be used to identify high-risk populations and patients who may necessitate greater resource utilization following elective cervical spinal fusion.
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Affiliation(s)
- Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles
- Department of Medical Engineering, California Institute of Technology, Pasadena
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Lee A Tan
- Department of Neurological Surgery, University of California, San Francisco, CA
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12
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Eubanks JE, Carlesso C, Sundaram M, Bejarano G, Smeets RJEM, Skolasky R, Vanushkina M, Turner R, Schneider MJ. Prehabilitation for spine surgery: A scoping review. PM R 2023; 15:1335-1350. [PMID: 36730164 DOI: 10.1002/pmrj.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/27/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full-text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self-efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.
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Affiliation(s)
- James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Cristiane Carlesso
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meenakshi Sundaram
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Geronimo Bejarano
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, Eindhoven, The Netherlands
- Pain in Motion International Research Group (PiM), Eindhoven, The Netherlands
| | - Richard Skolasky
- Orthopaedic Surgery and Physical Medicine & Rehabilitation, Spine Outcomes Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Vanushkina
- Interventional Spine and Musculoskeletal Physiatry, UCHealth Medical Group, Colorado Springs, Colorado, USA
| | - Rose Turner
- Liaison Services and Instruction, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Knudsen R, Polifka A, Markut KA, Price C, Mohamed B. The Impact of Multimodal Prehabilitation on Patient-Reported Outcomes for a Frail Octogenarian Undergoing Multilevel Lumbar Spinal Fusion Surgery: A Case Report. Cureus 2023; 15:e46836. [PMID: 37954746 PMCID: PMC10636751 DOI: 10.7759/cureus.46836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
This case report presents the perioperative optimization pathway of a frail octogenarian who underwent multilevel lumbar spinal fusion surgery. This patient was enrolled in a multimodal prehabilitation program for frail older adults. The multimodal prehabilitation program includes preoperative interventions that prevent further decline in physiological functions before spine surgery. The program focuses on physical exercise, nutritional intervention, and pain neuroscience education. Six weeks postoperatively, clinical and patient-reported outcomes improved in the categories targeted by the preoperative interventions and surgery. This report suggests that prehabilitation is feasible for preoperatively optimizing frail older adults undergoing complex spine surgery.
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Affiliation(s)
- Regina Knudsen
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Adam Polifka
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, USA
| | - Keri Ann Markut
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Catherine Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Yamada H. Sarcopenia at the upper instrumented vertebra is more significantly associated with proximal junctional kyphosis after long fusion for adult spinal deformity surgery than osteopenia. J Clin Neurosci 2023; 116:13-19. [PMID: 37597329 DOI: 10.1016/j.jocn.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
Proximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied patients older than 50 years who underwent ASD surgery from the lower thoracic spine to the pelvis. In addition to patient demographic data and pre- and post-operative radiographic sagittal parameters (PI: pelvic incidence; LL: lumbar lordosis; SVA: sagittal vertical axis; PT: pelvic tilt), Hounsfield unit (HU) values on preoperative computed tomography and cross sectional area (CSA) and fatty infiltration ratio (FI%) of the paraspinal musculature (PSM) on preoperative magnetic resonance image were measured from the upper-instrumented vertebra (UIV) to UIV + 2 and averaged. PJK was observed in 11 of 29 patients. There was no statistical difference between the patients with and without PJK in age at surgery, sex, body mass index, bone mineral density, preoperative PI-LL, SVA, PT, postoperative PI-LL, SVA, PT, HU, and CSA. FI% in patients with PJK (25.0) was significantly higher than that (15.3) in patients without PJK (P = 0.001). Logistic regression analysis identified FI% of PSM as a significant independent factor of PJK (odds ratio, 1.973; 95% confidence interval, 1.290-5.554; P < 0.0001). After successful elimination of possible factors related to PJK other than sarcopenia and osteopenia, sarcopenia assessed by fatty degeneration of the PSM at the UIV was shown to be a more important factor than osteopenia for PJK after long fusion for ASD.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Zhang Y, Feng B, Hu P, Dai G, Su W. One-hole split endoscopy technique versus unilateral biportal endoscopy technique for L5-S1 lumbar disk herniation: analysis of clinical and radiologic outcomes. J Orthop Surg Res 2023; 18:668. [PMID: 37689668 PMCID: PMC10492266 DOI: 10.1186/s13018-023-04159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Lumbar disk herniation (LDH) is one of the most common diseases of the spine, especially occurring in L4-5 and L5-S1 intervertebral disks, and surgery is a choice when conservative treatment is ineffective. The purpose of this study is to investigate the clinical efficacy and radiologic outcomes of one-hole split endoscopy (OSE) technique versus unilateral biportal endoscopy (UBE) technique in the treatment of L5-S1 lumbar disk herniation (LDH). METHODS A total of 133 patients of a single center surgically treated for L5-S1 LDH between 2019 and 2021 were retrospectively included in this study, of which 70 were treated by UBE technique and the rest were treated by OSE technique. Hospitalization time, operative time, intraoperative blood loss, fluoroscopy times, incision length and related complications were recorded. Bone resection area (BRA), articular process resection rate, range of motion (ROM), sagittal translation (ST), disk height (DH), Visual Analog Score (VAS), Oswestry Disability Index (ODI) and Macnab criteria were used to evaluated the clinical efficacy. RESULTS There was no statistically significant difference in hospitalization time or fluoroscopy times between the two groups. The operation time was shorter in the UBE group than that in the OSE group; however, the incision length was longer. Intraoperative blood loss and BRA were larger in the UBE group than in the OSE group. There was no significant difference in ROM, ST, DH, or postoperative facet resection rate between the two groups. There was no significant difference in ROM, ST, or postoperative facet resection rate compared with preoperative indicators in each group, but there was a significant difference in DH among distinct groups. At any time point, the lower back and leg VAS and ODI in each group were significantly improved compared to those before the operation, with no significant difference between the two groups. There was one case of dural tear in the UBE group. One case of transient hypoesthesia occurred in each of the two groups. The excellent-good rates of the UBE group and the OSE group were 88.6% and 90.5%, respectively. CONCLUSION The OSE technique is an effective minimally invasive surgical option as well as the UBE technique in the treatment of L5-S1 LDH.
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Affiliation(s)
- Yuhong Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China
| | - Bo Feng
- Department of Neurology, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China
| | - Peng Hu
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China.
| | - Guohua Dai
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China
| | - Weiliang Su
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe Er Road, Binzhou, 256603, Shandong, China
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16
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Engel D, Testa GD, McIsaac DI, Carli F, Santa Mina D, Baldini G, Scheede-Bergdahl C, Chevalier S, Edgar L, Beilstein CM, Huber M, Fiore JF, Gillis C. Reporting quality of randomized controlled trials in prehabilitation: a scoping review. Perioper Med (Lond) 2023; 12:48. [PMID: 37653530 PMCID: PMC10472732 DOI: 10.1186/s13741-023-00338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions.
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Affiliation(s)
- Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Giuseppe Dario Testa
- Department of Anesthesia, McGill University, Montréal, QC, Canada
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Department of Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, Faculty of Medicine, Faculty of Kinesiology and Physical Education, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gabriele Baldini
- Section of Anesthesiology, Intensive Care and Pain Medicine, Anesthesiology and Intensive Care Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Linda Edgar
- Prehabilitation Clinic, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montréal, QC, Canada.
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada.
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17
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Steinmetz C, Heinemann S, Kutschka I, Hasenfuß G, Asendorf T, Remppis BA, Knoglinger E, Grefe C, Albes JM, Baraki H, Baumbach C, Brunner S, Ernst S, Harringer W, Heider D, Heidkamp D, Herrmann-Lingen C, Hummers E, Kocar T, König HH, Krieger S, Liebold A, Martens A, Matzeder M, Mellert F, Müller C, Puls M, Reiss N, Schikora M, Schmidt T, Vestweber M, Sadlonova M, von Arnim CAF. Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial. Trials 2023; 24:533. [PMID: 37582774 PMCID: PMC10426165 DOI: 10.1186/s13063-023-07511-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients' pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors. METHODS In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention. DISCUSSION In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00030526). Registered on 30 January 2023.
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Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Ingo Kutschka
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University of Goettingen Medical Center, Goettingen, Germany
| | | | | | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Wesertal, Germany
| | | | - Hassina Baraki
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | | | | | - Susann Ernst
- ZAR Center for Outpatient Rehabilitation GmbH, Ulm, Germany
| | - Wolfgang Harringer
- Department of Cardiac, Thoracic and Vascular Surgery, Braunschweig Municipal Hospital, Brunswick, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Christoph Herrmann-Lingen
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Eva Hummers
- Department of General Practice, University of Goettingen Medical Center, Goettingen, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Simone Krieger
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Andreas Liebold
- Department for Thoracic, Cardiac and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Mellert
- Department of Cardiac Surgery, Oldenburg Hospital, Oldenburg, Germany
| | - Christiane Müller
- Department of General Practice, University of Goettingen Medical Center, Goettingen, Germany
| | - Miriam Puls
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Bad Rothenfelde, Germany
| | | | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Cologne, Germany
| | | | - Monika Sadlonova
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany.
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Zhang Y, Feng B, Ning H, Dai G, Su W, Lu H, Hu P. One-hole split endoscope technique for migrated lumbar disc herniation: a single-centre, retrospective study of a novel technique. J Orthop Surg Res 2023; 18:483. [PMID: 37408054 DOI: 10.1186/s13018-023-03967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is one of the most common diseases of the spine, and migrated LDH is a more serious type, associated with nerve root function injury or abnormality. Regarding the increasing surgery adoption of treating migrated LDH, we aimed to investigate the clinical efficacy and safety of discectomy with a novel technique-one-hole split endoscope (OSE) technique. METHODS This was a retrospective analysis of migrated LDH treated between December 2020 and September 2021. Hospitalization time, operative duration, intraoperative blood loss, number of fluoroscopy exposures, incision length, postoperative facet preservation rate, number of excellent-good cases, lower back and leg visual analogue score (VAS), Oswestry Disability Index (ODI) and surgical complications were compared between high-grade migration group (82 cases) and low-grade migration group (148 cases). The Macnab criteria was used to evaluate the clinical outcome. The Shapiro‒Wilk test was used to test measurement data, and the χ2 test was used to test counting data. RESULTS There was no significant difference in hospitalization time, operative duration, intraoperative blood loss, number of fluoroscopy exposures, incision length or postoperative facet preservation rate between the two groups by independent sample t test or nonparametric test. At any time point, the lower back and leg VAS and ODI of the two groups were significantly improved compared to those before the operation, but there was no significant difference between the two groups at the same time point by two-way repeated measures ANOVA. There were two cases of postoperative nerve root stimulation symptoms in the high-grade migration group and three cases in the low-grade migration group. There was one patient reoperated in the high-grade migration group. There was no significant difference in number of excellent-good cases between the two groups. The overall excellent-good rate was 89.6%. CONCLUSION The OSE technique has the advantages of less trauma, faster recovery, complete removal of the nucleus pulposus and a satisfactory early clinical efficacy in the treatment of migrated LDH.
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Affiliation(s)
- Yuhong Zhang
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Bo Feng
- Department of Neurology, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Huaxiu Ning
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Guohua Dai
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Weiliang Su
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Huaiwang Lu
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China
| | - Peng Hu
- Department of Spine Surgery, Binzhou Medical University Hospital, No. 661, Huanghe 2th Road, Binzhou, 256603, Shandong, China.
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Fong M, Kaner E, Rowland M, Graham HE, McEvoy L, Hallsworth K, Cucato G, Gibney C, Nedkova M, Prentis J, Madigan CD. The effect of preoperative behaviour change interventions on pre- and post-surgery health behaviours, health outcomes, and health inequalities in adults: A systematic review and meta-analyses. PLoS One 2023; 18:e0286757. [PMID: 37406002 DOI: 10.1371/journal.pone.0286757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Prehabilitation interventions are being delivered across surgical specialities to improve health risk behaviours leading to better surgical outcomes and potentially reduce length of hospital stay. Most previous research has focused on specific surgery specialities and has not considered the impact of interventions on health inequalities, nor whether prehabilitation improves health behaviour risk profiles beyond surgery. The aim of this review was to examine behavioural Prehabilitation interventions across surgeries to inform policy makers and commissioners of the best available evidence. METHODS AND FINDINGS A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to determine the effect of behavioural prehabilitation interventions targeting at least one of: smoking behaviour, alcohol use, physical activity, dietary intake (including weight loss interventions) on pre- and post-surgery health behaviours, health outcomes, and health inequalities. The comparator was usual care or no treatment. MEDLINE, PubMed, PsychINFO, CINAHL, Web of Science, Google Scholar, Clinical trials and Embase databases were searched from inception to May 2021, and the MEDLINE search was updated twice, most recently in March 2023. Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes were length of stay, six-minute walk test, behaviours (smoking, diet, physical activity, weight change, and alcohol), and quality of life. Sixty-seven trials were included; 49 interventions targeted a single behaviour and 18 targeted multiple behaviours. No trials examined effects by equality measures. Length of stay in the intervention group was 1.5 days shorter than the comparator (n = 9 trials, 95% CI -2.6 to -0.4, p = 0.01, I2 83%), although in sensitivity analysis prehabilitation had the most impact in lung cancer patients (-3.5 days). Pre-surgery, there was a mean difference of 31.8 m in the six-minute walk test favouring the prehabilitation group (n = 19 trials, 95% CI 21.2 to 42.4m, I2 55%, P <0.001) and this was sustained to 4-weeks post-surgery (n = 9 trials, mean difference = 34.4m (95%CI 12.8 to 56.0, I2 72%, P = 0.002)). Smoking cessation was greater in the prehabilitation group before surgery (RR 2.9, 95% CI 1.7 to 4.8, I2 84%), and this was sustained at 12 months post-surgery (RR 1.74 (95% CI 1.20 to 2.55, I2 43%, Tau2 0.09, p = 0.004)There was no difference in pre-surgery quality of life (n = 12 trials) or BMI (n = 4 trials). CONCLUSIONS Behavioural prehabilitation interventions reduced length of stay by 1.5 days, although in sensitivity analysis the difference was only found for Prehabilitation interventions for lung cancer. Prehabilitation can improve functional capacity and smoking outcomes just before surgery. That improvements in smoking outcomes were sustained at 12-months post-surgery suggests that the surgical encounter holds promise as a teachable moment for longer-term behavioural change. Given the paucity of data on the effects on other behavioural risk factors, more research grounded in behavioural science and with longer-term follow-up is needed to further investigate this potential.
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Affiliation(s)
- Mackenzie Fong
- NIHR Applied Research Collaboration, North East and North Cumbria, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Eileen Kaner
- NIHR Applied Research Collaboration, North East and North Cumbria, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Maisie Rowland
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Henrietta E Graham
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Louise McEvoy
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Kate Hallsworth
- NIHR Newcastle BRC, Newcastle upon Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Gabriel Cucato
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Carla Gibney
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Martina Nedkova
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - James Prentis
- Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle Upon Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Claire D Madigan
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Agarwal N, White MD, Roy S, Ozpinar A, Alan N, Lavadi RS, Okonkwo DO, Hamilton DK, Kanter AS. Long-Term Durability of Stand-Alone Lateral Lumbar Interbody Fusion. Neurosurgery 2023; 93:60-65. [PMID: 36757328 DOI: 10.1227/neu.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The long-term durability of stand-alone lateral lumbar interbody fusion (LLIF) remains unknown. OBJECTIVE To evaluate whether early patient-reported outcome measures after stand-alone LLIF are sustained on long-term follow-up. METHODS One hundred and twenty-six patients who underwent stand-alone LLIF between 2009 and 2017 were included in this study. Patient-reported outcome measures included the Oswestry Disability Index (ODI), EuroQOL-5D (EQ-5D), and visual analog score (VAS) scores. Durable outcomes were defined as scores showing a significant improvement between preoperative and 6-week scores without demonstrating any significant decline at future time points. A repeated measures analysis was conducted using generalized estimating equations (model) to assess the outcome across different postoperative time points, including 6 weeks, 1 year, 2 years, and 5 years. RESULTS ODI scores showed durable improvement at 5-year follow-up, with scores improving from 46.9 to 38.5 ( P = .001). Improvements in EQ-5D showed similar durability up to 5 years, improving from 0.48 to 0.65 ( P = .03). VAS scores also demonstrated significant improvements postoperatively that were durable at 2-year follow-up, improving from 7.0 to 4.6 ( P < .0001). CONCLUSION Patients undergoing stand-alone LLIF were found to have significant improvements in ODI and EQ-5D at 6-week follow-up that remained durable up to 5 years postoperatively. VAS scores were found to be significantly improved at 6 weeks and up to 2 years postoperatively but failed to reach significance at 5 years. These findings demonstrate that patients undergoing stand-alone LLIF show significant improvement in overall disability after surgery that remains durable at long-term follow-up.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael D White
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hoag Specialty Clinic, Hoag Neurosciences Institute, Newport Beach, California, USA
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21
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Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2023; 5:CD013259. [PMID: 37162250 PMCID: PMC10171468 DOI: 10.1002/14651858.cd013259.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes. OBJECTIVES To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VO2peak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible. MAIN RESULTS We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. The effects of prehabilitation on the number of complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250), emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250) and re-admissions (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250) were small or even trivial. The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. The effects on VO2peak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies. AUTHORS' CONCLUSIONS Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. A solid effect on the number of omplications, postoperative emergency department visits and re-admissions could not be established. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
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Affiliation(s)
| | | | | | - Rudi Mh Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
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22
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Punnoose A, Claydon-Mueller LS, Weiss O, Zhang J, Rushton A, Khanduja V. Prehabilitation for Patients Undergoing Orthopedic Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e238050. [PMID: 37052919 PMCID: PMC10102876 DOI: 10.1001/jamanetworkopen.2023.8050] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Importance Prehabilitation programs for patients undergoing orthopedic surgery have been gaining popularity in recent years. However, the current literature has produced varying results. Objective To evaluate whether prehabilitation is associated with improved preoperative and postoperative outcomes compared with usual care for patients undergoing orthopedic surgery. Data Sources Bibliographic databases (MEDLINE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], AMED [Allied and Complementary Medicine], Embase, PEDRO [Physiotherapy Evidence Database], and Cochrane Central Register of Controlled Trials) were searched for published trials, and the Institute for Scientific Information Web of Science, System for Information on Grey Literature in Europe, and European clinical trials registry were searched for unpublished trials from January 1, 2000, to June 30, 2022. Study Selection Randomized clinical trials (RCTs) comparing prehabilitation with standard care for any orthopedic surgical procedure were included. Data Extraction and Synthesis Two independent reviewers screened trials. Data were pooled using a random-effects model. Recommendations were determined using the Grading of Recommendations Assessment, Development and Evaluation system and the study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Main Outcomes and Measures Pain, function, muscle strength, and health-related quality of life (HRQOL). Results Forty-eight unique trials involving 3570 unique participants (2196 women [61.5%]; mean [SD] age, 64.1 [9.1] years) were analyzed. Preoperatively, moderate-certainty evidence favoring prehabilitation was reported for patients undergoing total knee replacement (TKR) for function (standardized mean difference [SMD], -0.70 [95% CI, -1.08 to -0.32]) and muscle strength and flexion (SMD, 1.00 [95% CI, 0.23-1.77]) and for patients undergoing total hip replacement (THR) for HRQOL on the 36-item Short Form Health Survey (weighted mean difference [WMD], 7.35 [95% CI, 3.15-11.54]) and muscle strength and abduction (SMD, 1.03 [95% CI, 0.03-2.02]). High-certainty evidence was reported for patients undergoing lumbar surgery for back pain (WMD, -8.20 [95% CI, -8.85 to -7.55]) and moderate-certainty evidence for HRQOL (SMD, 0.46 [95% CI, 0.13-0.78]). Postoperatively, moderate-certainty evidence favoring prehabilitation was reported for function at 6 weeks in patients undergoing TKR (SMD, -0.51 [95% CI, -0.85 to -0.17]) and at 6 months in those undergoing lumbar surgery (SMD, -2.35 [95% CI, -3.92 to -0.79]). Other differences in outcomes favoring prehabilitation were of low to very low quality of evidence. Conclusions and Relevance In this systematic review and meta-analysis of RCTs, moderate-certainty evidence supported prehabilitation over usual care in improving preoperative function and strength in TKR and HRQOL and muscle strength in THR, high-certainty evidence in reducing back pain, and moderate-certainty evidence in improving HRQOL in lumbar surgery. Postoperatively, moderate-certainty evidence supported prehabilitation for function following TKR at 6 weeks and lumbar surgery at 6 months. Prehabilitation showed promising results for other outcomes, although high risk of bias and heterogeneity affected overall quality of evidence. Additional RCTs with a low risk of bias investigating preoperative and postoperative outcomes for all orthopedic surgical procedures are required.
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Affiliation(s)
- Anuj Punnoose
- Young Adult Hip Service, Physiotherapy Department, Addenbrooke's-Cambridge University Hospitals NHS (National Health Service) Trust, Cambridge, United Kingdom
- School of Allied Health, Anglia Ruskin University, Chelmsford and Cambridge, United Kingdom
| | | | - Ori Weiss
- Department of Orthopedics, Meir Medical Centre, Kfar-Saba, Israel
| | - Jufen Zhang
- School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's-Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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23
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Sadlonova M, Katz NB, Jurayj JS, Flores L, Celano CM, von Arnim CA, Silver JK. Surgical prehabilitation in older and frail individuals: a scoping review. Int Anesthesiol Clin 2023; 61:34-46. [PMID: 36815461 PMCID: PMC10006316 DOI: 10.1097/aia.0000000000000394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Older individuals who are scheduled for elective procedures often have co-morbidities at baseline and may be classified as frail. Both older age and frailty are associated with poor fitness and preoperative deconditioning, which can be predictors of postoperative complications. Prehabilitation aims to improve preoperative health in order to reduce complications and expedite postoperative recovery. To date, the effect of prehabilitation on improving outcomes in older and frail individuals is unclear, and the evidence in support of multi-modal treatments is evolving. Methods: In this scoping review, searches of PubMed and Cochrane Library between August 2012 and August 2022 were performed to identify studies investigating the efficacy of prehabilitation prior to surgical procedures. Results: A total of 36 articles were included in the review. Most of these examined the efficacy of unimodal (n=21) prehabilitation interventions, most commonly exercise therapy. Multimodal prehabilitation programs (n=15) included a variety of intervention components (e.g., exercise training, nutrition, psychological intervention or geriatric consultation). The most commonly studied populations were patients with gastrointestinal cancer (mostly colorectal cancer). Exercise therapy and multimodal interventions are likely to be of greatest impact on postoperative functional decline in patients awaiting total knee or hip arthroplasty, and cancer-related resection surgery (e.g., due to colorectal, gastric or lung cancer) in older and frail patients. Conclusions: Presurgical prehabilitation showed the potential to diminish postoperative outcomes in older and frail patients prior to surgery. However, adequately powered, randomized controlled, assessor blinded intervention trials demonstrating overall benefit of prehabilitation are needed. Aims This scoping review aims to summarize the current literature on the efficacy of prehabilitation in older and frail individuals who are undergoing surgical procedures in order to support clinical protocols and inform future research.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Nicole B. Katz
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jane S. Jurayj
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Laura Flores
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Pester BD, Yoon J, Yamin JB, Papianou L, Edwards RR, Meints SM. Let’s Get Physical! A Comprehensive Review of Pre- and Post-Surgical Interventions Targeting Physical Activity to Improve Pain and Functional Outcomes in Spine Surgery Patients. J Clin Med 2023; 12:jcm12072608. [PMID: 37048691 PMCID: PMC10095133 DOI: 10.3390/jcm12072608] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The goal of this comprehensive review was to synthesize the recent literature on the efficacy of perioperative interventions targeting physical activity to improve pain and functional outcomes in spine surgery patients. Overall, research in this area does not yet permit definitive conclusions. Some evidence suggests that post-surgical interventions may yield more robust long-term outcomes than preoperative interventions, including large effect sizes for disability reduction, although there are no studies directly comparing these surgical approaches. Integrated treatment approaches that include psychosocial intervention components may supplement exercise programs by addressing fear avoidance behaviors that interfere with engagement in activity, thereby maximizing the short- and long-term benefits of exercise. Efforts should be made to test brief, efficient programs that maximize accessibility for surgical patients. Future work in this area should include both subjective and objective indices of physical activity as well as investigating both acute postoperative outcomes and long-term outcomes.
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Affiliation(s)
- Bethany D. Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
- Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-973-464-6386
| | - Jihee Yoon
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jolin B. Yamin
- Harvard Medical School, Boston, MA 02115, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Lauren Papianou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Samantha M. Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
- Harvard Medical School, Boston, MA 02115, USA
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25
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Alsaif H, Goodwin PC, Callaghan MJ, Sudell L, O'Neill TW, Yeowell G. Patient and healthcare provider experience and perceptions of a preoperative rehabilitation class for lumbar discectomy: A qualitative study. Musculoskelet Sci Pract 2023; 64:102740. [PMID: 36958123 DOI: 10.1016/j.msksp.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/29/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Lumbar disc disease is a leading cause of low back pain. Lumbar discectomy (LD) may be indicated if symptoms are not managed conservatively. Rehabilitation has traditionally been delivered postoperatively; however, there is increasing delivery preoperatively. There are few data concerning perceptions and experiences of preoperative rehabilitation. Exploring experiences of preoperative rehabilitation may help in the development and delivery of effective care for patients. OBJECTIVES To develop an understanding of patient and healthcare provider (HCP) experiences, perspectives and preferences of preoperative LD rehabilitation, including why patients do not attend. DESIGN A qualitative interpretive approach using focus groups and individual interviews. METHODS Data were collected from; a) patients listed for surgery and attended the preoperative rehabilitation (October 2019 to March 2020), b) patients listed for surgery but did not attend rehabilitation, and c) HCPs involved in the delivery of rehabilitation. Data were transcribed verbatim and analysed using thematic analysis. RESULTS/FINDINGS Twenty participants were included, twelve patients and eight HCPs. The preoperative class was a valuable service for both patients and HCPs. It provided a solution to staffing and time pressures. It provided the required education and exercise content helping the patients along their surgery pathway. Travel distance, transportation links, parking difficulty and cost, lack of knowledge about the class aims, and previous negative experiences were barriers to patient attendance. CONCLUSIONS For most patients and HCPs, the preoperative class was valuable. Addressing the challenges and barriers could improve attendance. Future research should focus on management of patient expectations and preferences preoperatively.
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Affiliation(s)
- Hanan Alsaif
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Physiotherapy, King Fahad Military Medical Complex - KFMMC Dhahran, Kingdom of Saudi Arabia
| | - Peter C Goodwin
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Michael J Callaghan
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Lindsay Sudell
- Department of Physiotherapy, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Gillian Yeowell
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine, And Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom; Department of Health and Professions, Manchester Metropolitan University, Manchester, United Kingdom
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Janssen ERC, Punt IM, Biemans CFM, van Rhijn L, Willems PC, van Meeteren NLU. Preoperative community based functional high intensity interval training ( f-HIIT) with high-risk patients opting for lumbar spinal fusion: a pilot study. Disabil Rehabil 2023; 45:805-813. [PMID: 35195480 DOI: 10.1080/09638288.2022.2040618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the feasibility, safety and preliminary effectiveness of preoperative functional high-intensity interval training (f-HIIT) for high-risk patients undergoing LSF. MATERIALS AND METHODS High-risk patients eligible for elective 1-3 level LSF were included. Feasibility and safety of the preoperative f-HIIT program was determined by measuring participation and attrition rates, training adherence, adverse events, reached training intensity and preoperative progression in physical fitness. Preliminary effect of the preoperative f-HIIT program was estimated on time to postoperative functional recovery and length of hospital stay (LoS) between high-risk patients who did and did not participate in the prehabilitation program. RESULTS Eleven out of 23 high-risk patients opted to participate in the f-HIIT program, which was safe and feasible, as no adverse events occurred and only one out of 74 sessions was missed (1.4%). Trained high-risk patients improved their physical fitness with 21.2% on average and obtained faster time to functional recovery compared to matched untrained patients (median 4.5 vs 7.5 days; p = 0.013). No effect was seen on LoS (median 7 vs 8 days (p = 0.58)). CONCLUSIONS The preoperative f-HIIT program is feasible, safe and shortened time to postoperative functional recovery in patients who underwent LSF.Implications for rehabilitationPreoperative high-intensity interval training is safe and feasible for high-risk patients opting for lumbar spinal fusion.In a relatively small sample the study shows preoperative high-intensity interval training could reduce time to functional recovery in high-risk patients opting for lumbar spinal fusion.
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Affiliation(s)
- Esther R C Janssen
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - Ilona M Punt
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Surgery and Trauma Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Camille F M Biemans
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Lodewijk van Rhijn
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Paul C Willems
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health ∼ Holland), The Hague, the Netherlands
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Topcare, Leiden, the Netherlands
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Pritchard MW, Lewis SR, Robinson A, Gibson SV, Chuter A, Copeland RJ, Lawson E, Smith AF. Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101806. [PMID: 36816345 PMCID: PMC9929685 DOI: 10.1016/j.eclinm.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention). METHODS In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008. FINDINGS We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I2 = 0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I2 = 25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias. INTERPRETATION Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA. FUNDING National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).
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Affiliation(s)
- Michael W. Pritchard
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | - Sharon R. Lewis
- Bone and Joint Health, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Amy Robinson
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | | | | | - Robert J. Copeland
- The Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Euan Lawson
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrew F. Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
- Corresponding author. Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK.
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The prognostic value of fear-avoidance beliefs on postoperative pain and dysfunction for lumbar degenerative disk disease: a meta-analysis. Int J Rehabil Res 2023; 46:3-13. [PMID: 36652201 DOI: 10.1097/mrr.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity ( I ² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76-3.00] and back-specific function (OR 3.13; 95% CI, 3.02-3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73-3.86) and function (OR 2.81; 95% CI, 2.57-3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.
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Lawrence DC, Montazeripouragha A, Wai EK, Roffey DM, Phan KM, Phan P, Stratton A, Kingwell S, McIntosh G, Soroceanu A, Abraham E, Bailey CS, Christie S, Paquet J, Glennie A, Nataraj A, Hall H, Fisher C, Rampersaud YR, Thomas K, Manson N, Johnson M, Zarrabian M. Beneficial Effects of Preoperative Exercise on the Outcomes of Lumbar Fusion Spinal Surgery. Physiother Can 2023; 75:22-28. [PMID: 37250725 PMCID: PMC10211389 DOI: 10.3138/ptc-2021-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 02/11/2024]
Abstract
Purpose: To determine whether there was an association between self-reported preoperative exercise and postoperative outcomes after lumbar fusion spinal surgery. Method: We performed a retrospective multivariable analysis of the prospective Canadian Spine Outcomes and Research Network (CSORN) database of 2,203 patients who had elective single-level lumbar fusion spinal surgeries. We compared adverse events and hospital length of stay between patients who reported regular exercise (twice or more per week) prior to surgery ("Regular Exercise") to those exercising infrequently (once or less per week) ("Infrequent Exercise") or those who did no exercise ("No Exercise"). For all final analyses, we compared the Regular Exercise group to the combined Infrequent Exercise or No Exercise group. Results: After making adjustments for known confounding factors, we demonstrated that patients in the Regular Exercise group had fewer adverse events (adjusted odds ratio 0.72; 95% CI: 0.57, 0.91; p = 0.006) and significantly shorter lengths of stay (adjusted mean 2.2 vs. 2.5 d, p = 0.029) than the combined Infrequent Exercise or No Exercise group. Conclusions: Patients who exercised regularly twice or more per week prior to surgery had fewer postoperative adverse events and significantly shorter hospital lengths of stay compared to patients that exercised infrequently or did no exercise. Further study is required to determine effectiveness of a targeted prehabilitation programme.
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Affiliation(s)
| | | | - Eugene K. Wai
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Darren M. Roffey
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kim M. Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philippe Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Stratton
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Kingwell
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg McIntosh
- Research Operations, Canadian Spine Outcomes Research Network, Markdale, Ontario, Canada
| | - Alex Soroceanu
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Edward Abraham
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Christopher S. Bailey
- Lawson Health Research Institute/London Health Sciences Centre, Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Sean Christie
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jerome Paquet
- Hôpital de l’Enfant-Jésus, Laval University, Quebec City, Quebec, Canada
| | - Andrew Glennie
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Y. Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Neil Manson
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Michael Johnson
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammad Zarrabian
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Effect of integrated exercise therapy and psychosocial interventions on self-efficacy in patients with chronic low back pain: A systematic review. J Psychosom Res 2023; 165:111126. [PMID: 36610335 DOI: 10.1016/j.jpsychores.2022.111126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, waitlists and attention controls for individuals with chronic low back pain (CLBP). METHODS MEDLINE, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used. RESULTS 2207 Participants were included (22-studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects: -0.02, 0.94) and controls (range of effects: 0.69, 0.80) and intermediately compared to usual care (range of effects: 0.11, 0.29); however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects: 0.57, 0.71), usual care (range of effects: -0.15, 0.94), and controls (range of effects: 0.31, 0.56), and intermediately compared to alternate interventions (1-study, effect: 0.57) and controls (1-study, effect: 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity. CONCLUSIONS EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short- and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
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Ali R, Hagan MJ, Bajaj A, Alastair Gibson J, Hofstetter CP, Waschke A, Lewandrowski KU, Telfeian AE. IMPACT OF THE LEARNING CURVE OF PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY ON CLINICAL OUTCOMES: A SYSTEMATIC REVIEW. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Mohamed B, Ramachandran R, Rabai F, Price CC, Polifka A, Hoh D, Seubert CN. Frailty Assessment and Prehabilitation Before Complex Spine Surgery in Patients With Degenerative Spine Disease: A Narrative Review. J Neurosurg Anesthesiol 2023; 35:19-30. [PMID: 34354024 PMCID: PMC8816967 DOI: 10.1097/ana.0000000000000787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023]
Abstract
Degenerative spine disease increases in prevalence and may become debilitating as people age. Complex spine surgery may offer relief but becomes riskier with age. Efforts to lessen the physiological impact of surgery through minimally invasive techniques and enhanced recovery programs mitigate risk only after the decision for surgery. Frailty assessments outperform traditional tools of perioperative risk stratification. The extent of frailty predicts complications after spine surgery such as reoperation for infection and 30-day mortality, as well as elements of social cost such as hospital length of stay and discharge to an advanced care facility. Symptoms of spine disease overlap with phenotypic markers of frailty; therefore, different frailty assessment tools may perform differently in patients with degenerative spine disease. Beyond frailty, however, cognitive decline and psychosocial isolation may interact with frailty and affect achievable surgical outcomes. Prehabilitation, which has reduced perioperative risk in colorectal and cardiac surgery, may benefit potential complex spine surgery patients. Typical prehabilitation includes physical exercise, nutrition supplementation, and behavioral measures that may offer symptomatic relief even in the absence of surgery. Nonetheless, the data on the efficacy of prehabilitation for spine surgery remains sparse and barriers to prehabilitation are poorly defined. This narrative review concludes that a frailty assessment-potentially supplemented by an assessment of cognition and psychosocial resources-should be part of shared decision-making for patients considering complex spine surgery. Such an assessment may suffice to prompt interventions that form a prehabilitation program. Formal prehabilitation programs will require further study to better define their place in complex spine care.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ramani Ramachandran
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Ferenc Rabai
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Catherine C. Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
| | - Adam Polifka
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Daniel Hoh
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
| | - Christoph N. Seubert
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- UF Health Comprehensive Spine Center, University of Florida, Gainesville, Florida
- Perioperative Cognitive Anesthesia Network, University of Florida College of Medicine, Gainesville, Florida
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Botros D, Khalafallah AM, Huq S, Dux H, Oliveira LAP, Pellegrino R, Jackson C, Gallia GL, Bettegowda C, Lim M, Weingart J, Brem H, Mukherjee D. Predictors and Impact of Postoperative 30-Day Readmission in Glioblastoma. Neurosurgery 2022; 91:477-484. [PMID: 35876679 PMCID: PMC10553112 DOI: 10.1227/neu.0000000000002063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/26/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Postoperative 30-day readmissions have been shown to negatively affect survival and other important outcomes in patients with glioblastoma (GBM). OBJECTIVE To further investigate patient readmission risk factors of primary and recurrent patients with GBM. METHODS The authors retrospectively reviewed records of 418 adult patients undergoing 575 craniotomies for histologically confirmed GBM at an academic medical center. Patient demographics, comorbidities, and clinical characteristics were collected and compared by patient readmission status using chi-square and Mann-Whitney U testing. Multivariable logistic regression was performed to identify risk factors that predicted 30-day readmissions. RESULTS The cohort included 69 (12%) 30-day readmissions after 575 operations. Readmitted patients experienced significantly lower median overall survival (11.3 vs 16.4 months, P = .014), had a lower mean Karnofsky Performance Scale score (66.9 vs 74.2, P = .005), and had a longer initial length of stay (6.1 vs 5.3 days, P = .007) relative to their nonreadmitted counterparts. Readmitted patients experienced more postoperative deep vein thromboses or pulmonary embolisms (12% vs 4%, P = .006), new motor deficits (29% vs 14%, P = .002), and nonhome discharges (39% vs 22%, P = .005) relative to their nonreadmitted counterparts. Multivariable analysis demonstrated increased odds of 30-day readmission with each 10-point decrease in Karnofsky Performance Scale score (odds ratio [OR] 1.32, P = .002), each single-point increase in 5-factor modified frailty index (OR 1.51, P = .016), and initial presentation with cognitive deficits (OR 2.11, P = .013). CONCLUSION Preoperatively available clinical characteristics strongly predicted 30-day readmissions in patients undergoing surgery for GBM. Opportunities may exist to optimize preoperative and postoperative management of at-risk patients with GBM, with downstream improvements in clinical outcomes.
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Affiliation(s)
- David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M. Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sakibul Huq
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hayden Dux
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leonardo A. P. Oliveira
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Pellegrino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary L. Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lam AK, Fung OH, Kwan C, Cheung JP, Luk KD, Chiu AY, Descarreaux M, Szeto GP, Wong AY. The Concerns and Experiences of Patients With Lumbar Spinal Stenosis Regarding Prehabilitation and Recovery After Spine Surgery: A Qualitative Study. Arch Rehabil Res Clin Transl 2022; 4:100227. [PMID: 36545515 PMCID: PMC9761253 DOI: 10.1016/j.arrct.2022.100227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives To improve our understanding of patients' perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences. Design Qualitative research with semi-structured interviews. Setting General community. Participants Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview. Interventions Not applicable. Main Outcome Measures Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery. Results Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time. Conclusions Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.
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Affiliation(s)
- Alan K.H. Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Olivia H.Y. Fung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Crystal Kwan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jason P.Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Keith D.K. Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Alice Y.Y. Chiu
- Department of Physiotherapy, Duchess of Kent Children's Hospital, Hong Kong SAR, China
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Grace P.Y. Szeto
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - Arnold Y.L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China,Corresponding author Arnold Y.L. Wong, PhD, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China.
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Shahi P, Vaishnav AS, Melissaridou D, Sivaganesan A, Sarmiento JM, Urakawa H, Araghi K, Shinn DJ, Song J, Dalal SS, Iyer S, Sheha ED, Dowdell JE, Qureshi SA. Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery. Spine (Phila Pa 1976) 2022; 47:1137-1144. [PMID: 35797654 DOI: 10.1097/brs.0000000000004380] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF). SUMMARY OF BACKGROUND DATA Assessing postoperative inefficiencies is vital to increase the feasibility of ALF. MATERIALS AND METHODS Patients who underwent single-level minimally invasive transforaminal lumbar interbody fusion and would have met the eligibility criteria for ALF were included. Length of stay (LOS); time in postanesthesia recovery unit (PACU); alertness and neurological examination, and pain scores at three and six hours; type of analgesia; time to physical therapy (PT) visit; reasons for PT nonclearance; time to per-oral (PO) intake; time to voiding; time to readiness for discharge were assessed. Time taken to meet each discharge criterion was calculated. Multiple regression analyses were performed to study the effect of variables on postoperative parameters influencing discharge. RESULTS Of 71 patients, 4% were discharged on the same day and 69% on postoperative day 1. PT clearance was the last-met discharge criterion in 93%. Sixty-six percent did not get PT evaluation on the day of surgery. Seventy-six percent required intravenous opioids and <60% had adequate pain control. Twenty-six percent had orthostatic intolerance. The median postoperative LOS was 26.9 hours, time in PACU was 4.2 hours, time to PO intake was 6.5 hours, time to first void was 6.3 hours, time to first PT visit was 17.7 hours, time to PT clearance was 21.8 hours, and time to discharge readiness was 21.9 hours. Regression analysis showed that time to PT clearance, time to PO intake, time to voiding, time in PACU, and pain score at three hours had a significant effect on LOS. CONCLUSIONS Unavailability of PT, surgery after 1 pm , orthostatic intolerance, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Avani S Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Jose M Sarmiento
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Hikari Urakawa
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Daniel J Shinn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sidhant S Dalal
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
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Mansell G, den Hollander M, Lotzke H, Smeets RJEM, Lundberg M. A Person-Centred Prehabilitation Program based on Cognitive-Behavioural Physical Therapy for patients scheduled for Lumbar Fusion surgery: A mediation analysis to assess fear of movement (kinesiophobia), self-efficacy, and catastrophizing as mediators of health outcomes. Eur J Pain 2022; 26:1790-1799. [PMID: 35802065 PMCID: PMC9543490 DOI: 10.1002/ejp.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 12/02/2022]
Abstract
Objective To investigate whether early changes in fear of movement (kinesiophobia), self‐efficacy and catastrophizing were mediators of the relationship between allocation to the pre‐habilitation intervention and later changes in health outcomes. Methods The original pre‐habilitation trial (PREPARE, ISRCTN17115599) recruited 118 participants awaiting lumbar fusion surgery, half of whom received a prehabilitation intervention designed based on the modified fear‐avoidance model and half of whom received usual care. Mediation analysis was performed to test each mediator separately. Analysis was performed on each outcome of interest separately (Oswestry disability index, patient‐specific function, EQ general health and moderate/vigorous physical activity). Mediation analysis was carried out using PROCESS. Beta coefficients and bootstrapped 95% CIs were used to interpret the results. Results None of the potential mediators was found to mediate the relationship between allocation to the intervention and 3‐month scores on any of the health outcomes tested. Conclusions Screening patients for higher levels of catastrophizing and fear avoidance and lower levels of self‐efficacy could help ensure only the patients who are most likely to benefit from the intervention are included. Significance Prehabilitation interventions for spinal fusion surgery have been found to improve health outcomes for patients. Theory‐based interventions that target key mechanisms are more effective at improving outcomes than non‐theory‐based interventions. While no mediating effects were found for this particular intervention, the analysis suggests that the underlying theoretical model and treatment targets are appropriate and could drive improvement if more strongly targeted.
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Affiliation(s)
- G Mansell
- School of Psychology, Aston University, Aston Triangle, B4 7ET, Birmingham, UK
| | - M den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, and Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University
| | - H Lotzke
- Back in Motion Research Group, Ängelholm Hospital, Department of Rehabilitation, 262 81, Ängelholm, Sweden
| | - R J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, location Eindhoven, The Netherlands
| | - M Lundberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,University of Gothenburg, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
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Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2022; 5:CD013259. [PMID: 35588252 PMCID: PMC9118366 DOI: 10.1002/14651858.cd013259.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes. OBJECTIVES To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VO2peak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible. MAIN RESULTS We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. Prehabilitation may also result in fewer complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250) and fewer emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250). The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. On the other hand, prehabilitation may also result in a higher re-admission rate (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250). The certainty of evidence was again low due to downgrading for risk of bias and imprecision. The effect on VO2peak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies. AUTHORS' CONCLUSIONS Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. Complication rates and the number of emergency department visits postoperatively may also diminish due to a prehabilitation programme, while the number of re-admissions may be higher in the prehabilitation group. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
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Affiliation(s)
| | | | | | - Rudi Mh Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
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Zhu W, Yao Y, Hao J, Li W, Zhang F. Short-Term Postoperative Pain and Function of Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Single-Segment Lumbar Disc Herniation: A Systematic Review and Meta-analysis. Appl Bionics Biomech 2022; 2022:5360277. [PMID: 35465181 PMCID: PMC9023232 DOI: 10.1155/2022/5360277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Spinal surgery is gradually moving toward minimally invasive surgery, but there is still some lack of knowledge about the Unilateral Biportal Endoscopic (UBE) technique that has been hotly debated in recent years. We performed this systematic review and meta-analysis to clarify whether UBE is superior to percutaneous endoscopic lumbar discectomy (PELD) for relieving short-term postoperative pain and promoting functional recovery. Methods Computer searches of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang databases were performed to search for studies on UBE versus PELD for single-segment lumbar disc herniation (ssLDH) from the time of database construction to Mar. 2022, and two investigators independently performed literature screening and data extraction, and evaluation of the quality of the included studies was observed as operation time, complications, and visual analogue scale (VAS) at each preoperative and postoperative stage as well as Oswestry Disability Index (ODI), and meta-analysis was performed by applying the Review Manager 5.4 software. Results Meta-analysis showed that PELD had shorter operation time (MD = 35.36, 95% CI (4.67, 66.04), P = 0.02) and had lower VAS of back pain at 3 days postoperatively (MD = 0.62, 95% CI (0.04, 1.19), P = 0.04) compared to the UBE. However, there was no statistical significance between the two groups in terms of complications (MD = 2.53, 95% CI (0.40, 16.11), P = 0.33), VAS of back pain at 30 days postoperatively (MD = 0.05, 95% CI (-0.19, 0.28), P = 0.70), VAS of leg pain at 3 days postoperatively (MD = 0.21, 95% CI (-0.20, 0.61), P = 0.33), VAS of leg pain at 30 days postoperatively (MD = 0.09, 95% CI (-0.29, 0.46), P = 0.65), and ODI at 30 days postoperatively (MD = -0.81, 95% CI (-3.03, 1.41), P = 0.47). Conclusions Current evidence suggests that both UBE and PELD are effective in relieving short-term postoperative pain and promoting functional recovery, and there is no difference in complications between them; UBE requires longer operation time, and PELD may be superior in relieving immediate postoperative pain. This trial is registered with PROSPERO ID: CRD42021287810.
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Affiliation(s)
- Weihao Zhu
- Medical School of Nantong University, Nantong, Jiangsu Province 226001, China
| | - Yu Yao
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, China
| | - Jie Hao
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, China
| | - Wenbin Li
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province 226001, China
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Duarte ST, Nunes C, Costa D, Donato H, Cruz EB. Models of care for low back pain patients in primary healthcare: a scoping review protocol. BMJ Open 2022; 12:e053848. [PMID: 35379620 PMCID: PMC8981342 DOI: 10.1136/bmjopen-2021-053848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is the most prevalent musculoskeletal condition worldwide and it is responsible for high healthcare costs and resources consumption. It represents a challenge for primary care services that struggle to implement evidence-based practice. Models of care (MoCs) are arising as effective solutions to overcome this problem, leading to better health outcomes. Although there is growing evidence regarding MoCs for the management of LBP patients, an analysis of the existing body of evidence has not yet been carried out. Therefore, this scoping review aims to identify and map the current evidence about the implementation of MoCs for LBP in primary healthcare. Findings from this study will inform policy makers, health professionals and researchers about their characteristics and outcomes, guiding future research and best practice models. METHODS AND ANALYSIS This protocol will follow the Joanna Briggs Institute methodological guidelines for scoping reviews. Studies that implemented an MoC for LBP patients in primary healthcare will be included. Searches will be conducted on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science, grey literature databases and relevant organisations websites. This review will consider records from 2000, written in English, Portuguese or Spanish. Two researchers will independently screen all citations and full-text articles and abstract data. Data extracted will include the identification of the MoC, key elements of the intervention, organisational components, context-specific factors and patient-related, system-related and implementation-related outcomes. ETHICS AND DISSEMINATION As a secondary analysis, this study does not require ethical approval. It will provide a comprehensive understanding on existing MoCs for LBP, outcomes and context-related challenges that may influence implementation in primary healthcare, which is meaningful knowledge to inform future research in this field. Findings will be disseminated through research papers in peer-reviewed journals, presentations at relevant conferences and documentation for professional organisations and stakeholders.
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Affiliation(s)
- Susana Tinoco Duarte
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
| | - Carla Nunes
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
| | - Daniela Costa
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisboa, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Eduardo B Cruz
- Comprehensive Health Research Center, NOVA University of Lisbon, Lisboa, Portugal
- Physical Therapy Department, Polytechnic Institute of Setúbal, Setubal, Portugal
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Maximum gait speed and lumbar spinal mobility can affect quality of life in elderly women with lumbar kyphosis. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100100. [PMID: 35281994 PMCID: PMC8907301 DOI: 10.1016/j.xnsj.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022]
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Ziegler DS, Westermann CE, Aalling AF, O'Neill SFD, Andersen MO. The association between sociodemographic characteristics and the event of undergoing first-time, simple lumbar discectomy: A case-control study. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100106. [PMID: 35281995 PMCID: PMC8907305 DOI: 10.1016/j.xnsj.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Educational level and pre-OP sick leave affect the probability of lumbar discectomy. Discectomy is more common with low socioeconomic status compared to high status. Sociodemographic factors should be noted for their importance in choice of treatment.
Background In disc herniation, nonsurgical treatments are recommended prior to elective discectomy but are often associated with consultation fees, whereas the discectomy itself may be without user payment. This may affect individual preferences in the choice of treatment. This retrospective case-control study examined the association between socioeconomic characteristics and the event of undergoing a first-time, single-level, simple lumbar discectomy. Methods The consecutively formed study population comprised patients undergoing elective lumbar discectomy at a Danish public hospital between 2010 and 2013. A national authority identified three gender- and age-matched controls per case for comparison. Measures investigated in this study were marital status, ethnicity, socioeconomic classification, educational level, the extent of sick leave 52 weeks prior to surgery, personal income, and equivalized disposable household income. All measures were provided by national registries. The associations were examined using uni- and multivariate logistic regression analysis. Results In a study population of 888 operated patients (age (SD) 46 (14); ODI (SD) 47 (18); leg pain intensity (VAS) (iqr) 74 (33), EQ-5D (iqr) 0.26 (0.62)) compared to 2664 controls, the probability of undergoing lumbar discectomy was significantly associated with lower vs. higher educational levels ((OR 1.98-2.53), and with periods of sick leave exceeding two weeks within one year prior to surgery (OR 9.47 (95% CI 7.68-11.68)). In the multivariate analysis, the event of undergoing discectomy was insignificantly associated with any other socioeconomic characteristics, whereas the personal income was of significant importance in the univariate analysis. Conclusion The event of undergoing free-of-fee elective first-time, single-level, simple lumbar discectomy is more common among individuals with low educational levels and unstable labor market attachment when examined in a case-control study. Being a multifactorial challenge, this calls upon the active engagement of several policy sectors.
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Affiliation(s)
- Dorthe Schoeler Ziegler
- Medical Spinal Research Unit, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Corresponding author.
| | - Clara Emilie Westermann
- Faculty of Health Sciences, University of Southern, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Ann Fredsted Aalling
- Faculty of Health Sciences, University of Southern, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Soeren Francis Dyhrberg O'Neill
- Medical Spinal Research Unit, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Mikkel Oesterheden Andersen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
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Charlotte D, Mathew NH, Tamir A, Michael B, Raphaële CM, Nicolas D, Marcel D, Charles F, Brian KK, Scott P, John S. Variations in LOS and its main determinants overtime at an academic spinal care center from 2006-2019. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:702-709. [PMID: 35013829 PMCID: PMC8747860 DOI: 10.1007/s00586-021-07086-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 01/14/2023]
Abstract
Objectives Efforts to safely reduce hospital LOS while maintaining quality outcomes and patient satisfaction are paramount. The primary goal of this study was to assess trends in LOS at a high-volume quaternary care spine center. Secondary goals were to assess trends in factors most associated with prolonged LOS. Methods This is a prospective study of all consecutive patients admitted from January 2006 to December 2019. Data included demographics, diagnostic category (degenerative, oncology, deformity, trauma, other), LOS (mean, median, interquartile range, standard deviation, defined as days from admission to discharge), and in-hospital adverse events. Results A total of 13,493 patients were included. Overall LOS has not changed over time with an overall median of 6.3 days (p = 0.451). Median LOS significantly increased for patients treated for degenerative pathology from 2.2 days in 2006 to 3.2 days in 2019 (p = 0.019). LOS has not changed for patients treated for deformity (overall median 6.8 days, p = 0.411), oncology (overall median 11.0 days, p = 0.051), or trauma (overall median 11.8 days, p = 0.582). Emergency admissions increased 3.2%/year for degenerative pathologies (p = < 0.001). Mean age has increased from 48.4 years in 2006 to 58.1 years in 2019 (p = < 0.001). This trend was observed in the deformity, degenerative and trauma group, not for patients treated for oncological disease. More adverse events were significantly associated with increasing age. Conclusion This is the first North American study to comprehensively analyze trends in LOS for spinal surgery overtime in an academic center. Overall, LOS has not changed from 2006–2019. Various factors that influence LOS appear to have balanced each other. It may also be explained by the changing epidemiology of both elective and emergency surgeries. These findings provide opportunities for intervention and improvement, targeted at the geriatric population, to reduce length of hospitalization.
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Affiliation(s)
- Dandurand Charlotte
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - N Hindi Mathew
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Ailon Tamir
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Boyd Michael
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Charest-Morin Raphaële
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Dea Nicolas
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Dvorak Marcel
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Fisher Charles
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - K Kwon Brian
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Paquette Scott
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Street John
- Combined Neurosurgical and Orthopedic Spine Program, Blusson Spinal Cord Center, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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van Gestel T, Groen LCB, Puik JR, van Rooijen SJ, van der Zaag-Loonen HJ, Schoonmade LJ, Danjoux G, Daams F, Schreurs WH, Bruns ERJ. Fit4Surgery for cancer patients during covid-19 lockdown – A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1189-1197. [PMID: 35183411 PMCID: PMC8828288 DOI: 10.1016/j.ejso.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Affiliation(s)
- T van Gestel
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands.
| | - L C B Groen
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - J R Puik
- Department of Surgery, Amsterdam University Medical Center Location VU, Amsterdam, the Netherlands
| | - S J van Rooijen
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G Danjoux
- South Tees Hospitals NHS Foundation Trust, UK; Honorary Professor, Hull York Medical School and Teesside University, UK
| | - F Daams
- Department of Surgery, Amsterdam University Medical Center Location VU, Amsterdam, the Netherlands
| | - W H Schreurs
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - E R J Bruns
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
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Cha EDK, Lynch CP, Patel MR, Jacob KC, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Preoperative Duration of Symptoms Does Not Affect Outcomes of Anterior Lumbar Interbody Fusion. Neurosurgery 2022; 90:215-220. [PMID: 34995271 DOI: 10.1227/neu.0000000000001782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have examined the impact of preoperative duration of symptoms (DOS) on lumbar spinal surgery outcomes although this has not been explored for anterior lumbar interbody fusion (ALIF). OBJECTIVE To assess the impact of preoperative DOS on patient-reported outcome measures (PROMs) of ALIF with posterior instrumentation. METHODS A database was retrospectively reviewed for ALIFs with posterior instrumentation. PROMs recorded at preoperative, 6-wk, 12-wk, 6-mo, and 1-yr postoperative timepoints included Visual Analog Scale back and leg, Oswestry Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and PROM Information System physical function. Achievement of minimum clinically important difference (MCID) was determined by comparing differences in postoperative PROMs from baseline to established values. Patients were grouped based on preoperative DOS into <1-yr and ≥1-yr groups. Differences in PROMs were compared using a t-test, whereas MCID achievement used a χ2 test. RESULTS Fifty-three patients were included, with 20 in the <1-yr group and 33 in the ≥1-yr group. The most common diagnosis was isthmic spondylolisthesis. No significant preoperative differences were observed in any PROM. DOS groups demonstrated significantly different scores for SF-12 PCS at 6 wk (P = .049). No significant differences in MCID achievement were observed between groups for any PROM. CONCLUSION ALIF patients demonstrated similar levels of pain, disability, and physical function regardless of preoperative DOS, except for back pain and physical function at intermittent timepoints. MCID achievement did not differ based on DOS for all outcome measures.
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Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Perry R, Herbert G, Atkinson C, England C, Northstone K, Baos S, Brush T, Chong A, Ness A, Harris J, Haase A, Shah S, Pufulete M. Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open 2021; 11:e050806. [PMID: 34593498 PMCID: PMC8487197 DOI: 10.1136/bmjopen-2021-050806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020). SETTING Secondary care. PARTICIPANTS Patients (≥18 years) undergoing major elective surgery (curative or palliative). INTERVENTIONS Any intervention administered in the preoperative period with the aim of improving postoperative outcomes. OUTCOMES AND MEASURES Primary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use. REVIEW METHODS Two authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials. RESULTS 178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: -1.81 days, 95% CI -2.31 to -1.31; -2.11 days, 95% CI -3.07 to -1.15; -1.67 days, 95% CI -2.31 to -1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64). CONCLUSIONS Some prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low. PROSPERO REGISTRATION NUMBER CRD42015019191.
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Affiliation(s)
- Rachel Perry
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Georgia Herbert
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Clare England
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Baos
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Brush
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Chong
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
- School of Oral and Dental Science, University of Bristol, Bristol, UK
| | - Jessica Harris
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Anne Haase
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sanjoy Shah
- University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
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Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol 2021; 34:257-276. [PMID: 34483301 DOI: 10.1097/ana.0000000000000799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022]
Abstract
Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.
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Moses ZB, Oh SY, Fontes RBV, Deutsch H, O'Toole JE, Fessler RG. The modified frailty index and patient outcomes following transforaminal lumbar interbody fusion surgery for single-level degenerative spine disease. J Neurosurg Spine 2021; 35:163-169. [PMID: 34087787 DOI: 10.3171/2020.11.spine201263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The modified frailty index (mFI) is a simple tool that measures physiological reserve based on a thorough history and physical examination. Its use has been validated in several surgical specialties, including spinal deformity surgery. Prior research has suggested no significant differences in clinical outcomes between elderly and nonelderly patients undergoing posterior lumbar interbody fusion. The authors sought to investigate the use of the mFI in patients undergoing transforaminal lumbar interbody fusion (TLIF) and the relationship between frailty scores and clinical outcomes. METHODS A retrospective chart review was conducted on 198 patients who underwent a single-level TLIF over a 60-month period at a single institution. For all patients, an mFI score was computed incorporating a set of 11 clinical factors to assess preexisting comorbidities and functional status. Clinical follow-up and health-related quality-of-life (HRQOL) scores were obtained at baseline and regular intervals of 6 weeks, 6 months, and 1 year following surgery. RESULTS Patients were grouped according to their level of frailty: no frailty (mFI = 0), mild frailty (mFI = 0.09), moderate frailty (mFI = 0.18), and severe frailty (mFI ≥ 0.27). One-way ANOVA revealed increasing levels of frailty to be associated with an increased rate of complications, from 10.3% to 63.6%. In addition, increasing levels of frailty were associated with longer hospital length of stay (LOS), from 3.1 days to 6.5 days, and lower rates of disposition to home. At the 1-year follow-up, increased levels of frailty were associated with worse HRQOL measures. CONCLUSIONS Increasing mFI score was associated with higher morbidity, longer inpatient LOS, and a lower probability of discharge to home in patients undergoing single-level TLIF. Consideration of the mFI may help surgeons improve decision-making across the spectrum of patients who are at risk from frailty.
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Pre-operative patient education does not necessarily reduce length of stay or pain after spinal surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Theologis AA, Lau D, Dalle-Ore C, Tsu A, Deviren V, Ames CP. Costs and utility of post-discharge acute inpatient rehabilitation following adult spinal deformity surgery. Spine Deform 2021; 9:817-822. [PMID: 33400227 DOI: 10.1007/s43390-020-00251-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Evaluate costs and functional utility of post-discharge rehabilitation after surgery for adult spinal deformity (ASD). METHODS Retrospective analysis of ASD patients who underwent operation at a single center and discharged to one rehabilitation facility. Operative details and costs were obtained for index inpatient encounter. Rehabilitation data included: direct costs, length of stay, and patient function, as assessed by Functional Independence Measure (FIM) instrument. RESULTS Of 937 operations, 391 (41.7%) were discharged to rehabilitation. Ninety-patients (9.6%; 95 care episodes; average age 70.5 ± 10.6 years) were discharged to rehabilitation. Inpatient length of stay was 8.2 ± 2.6 days. Operative details: posterior levels fused 13.6 ± 3.6, PCOs/patient 7 ± 3.7, forty-two 3-column osteotomies, and 11 inter-body fusions. Direct costs were $90,738 ± $24,166 for index hospitalizations and $38,808 ± $14,752 for rehabilitation. Patients spent 11.7 ± 4.0 days in rehabilitation. Direct cost per day in hospital ($11,758 ± $3390) was significantly greater than rehabilitation ($3338 ± $2131) (p < 0.05). Significant improvements in function while in rehabilitation were observed (admit FIM: 66 ± 14 vs. discharge FIM: 94 ± 14). Charlson Comorbidity Index was the only independent predictor of rehabilitation direct costs. Conclusion Post-discharge inpatient rehabilitation following operations for ASD is associated with a direct cost of $38,808 per case. While rehabilitation resulted in significant functional improvements, it came at significant economic expense ($3.7 million) that accounted for 30% of costs for 95 episodes of care. For 100 operatively treated patients (assuming 41% discharge rate to rehab), rehabilitation results in an additional price premium of $1,674,872.
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Affiliation(s)
- Alekos A Theologis
- Department of Orthopaedic Surgery, University of CA-San Francisco (UCSF), 500 Parnassus Ave, MU West 3rd Floor, San Francisco, CA, 94143, USA.
| | - Darryl Lau
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | | | - Adelyn Tsu
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of CA-San Francisco (UCSF), 500 Parnassus Ave, MU West 3rd Floor, San Francisco, CA, 94143, USA
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Zhang Y, Zhang Z, Chen P, Ma CY, Li C, Au TYK, Tam V, Peng Y, Wu R, Cheung KMC, Sham PC, Tse HF, Chan D, Leung VY, Cheah KSE, Lian Q. Directed Differentiation of Notochord-like and Nucleus Pulposus-like Cells Using Human Pluripotent Stem Cells. Cell Rep 2021; 30:2791-2806.e5. [PMID: 32101752 DOI: 10.1016/j.celrep.2020.01.100] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 10/15/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022] Open
Abstract
Intervertebral disc degeneration might be amenable to stem cell therapy, but the required cells are scarce. Here, we report the development of a protocol for directed in vitro differentiation of human pluripotent stem cells (hPSCs) into notochord-like and nucleus pulposus (NP)-like cells of the disc. The first step combines enhancement of ACTIVIN/NODAL and WNT and inhibition of BMP pathways. By day 5 of differentiation, hPSC-derived cells express notochordal cell characteristic genes. After activating the TGF-β pathway for an additional 15 days, qPCR, immunostaining, and transcriptome data show that a wide array of NP markers are expressed. Transcriptomically, the in vitro-derived cells become more like in vivo adolescent human NP cells, driven by a set of influential genes enriched with motifs bound by BRACHYURY and FOXA2, consistent with an NP cell-like identity. Transplantation of these NP-like cells attenuates fibrotic changes in a rat disc injury model of disc degeneration.
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Affiliation(s)
- Yuelin Zhang
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China
| | - Zhao Zhang
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China
| | - Peikai Chen
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Chui Yan Ma
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Cheng Li
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Tiffany Y K Au
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Vivian Tam
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Yan Peng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ron Wu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Pak C Sham
- Centre for PanorOmic Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Hung-Fat Tse
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Danny Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Victor Y Leung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Kathryn S E Cheah
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
| | - Qizhou Lian
- Department of Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong; Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, Guangdong 510080, China; The State Key Laboratory of Pharmaceutical Biotechnology, the University of Hong Kong, Hong Kong.
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