Journal Article

The Effect of Physical Therapy on Time to Discharge After Lumbar Interbody Fusion

Massie, Lara W, Chang, Victor, Fakih, Mohamed, Elmenini, Jaafar, Macki, Mohamed, Zakaria, Hesham Mostafa, Dakroub, Belal

2020

Overview

•Mean distance ambulated upon first interaction with physical therapy was longest among patients discharged on the postoperative day (POD) 1 group and significantly decreased to POD 2 and POD ≥ 3 group.•The odds of longer length of stay decreased by 35% for every 50 ft ambulated.•Patient-reported outcomes (PROs) did not differ among the three cohorts. Preoperative Oswestry Disability Index (ODI) failed to predict time to discharge in the logistical regression analysis. With a lesser degree of tissue destruction, patients undergoing minimally-invasive spine surgery are primed to benefit from early mobilization, which can further enhance recovery and hasten rehabilitation. We aimed to determine the role of physical therapy on earlier discharge after minimally-invasive transforaminal lumbar interbody fusion (TLIF). Michigan Spine Surgery Improvement Collaborative (MSSIC) provided patients undergoing one- and two-level minimally-invasive TLIF for degenerative lumbar disease. The study population was divided into patients with a one-day length of stay (LOS 1), two days (LOS 2), and three or more days (LOS ≥ 3) to maintain three equal-time cohorts. On POD 0, physical therapy (or, in very rare circumstances, a spine-care-specialized nurse in patients arriving to the in-patient floors late after hours) must evaluate capacity to ambulate. Of the 101 patients, the median day of first ambulation statistically significantly increased from the LOS 1 to LOS ≥ 3 cohort (P = 0.007). Mean distance ambulated decreased from 156.5 ± 123.1 feet in the LOS 1 group, 108.9 ± 83.9 feet in the LOS 2 group, to 69.2 ± 58.3 feet in the LOS ≥ 3 group (P = 0.002). Patient-reported outcomes did not differ among the three cohorts. Following a multivariable ordinal logistical regression controlling for disposition to rehab over home (ORadj = 5.47, P = 0.045), the odds of longer LOS decreased by 39% for every 50-feet ambulated (P = 0.002). Time to first ambulation independently increases the odds of earlier discharge, regardless of comorbidity burden and surgical determinants.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Activities of daily living / Ambulation / Back surgery / Bone surgery / Cardiovascular disease / Catheters / Comorbidity / Diabetes / Discharge / Electronic health records / Feet / Hospitals / Lateral Lumbar Interbody Fusion / Medical records / Neurology / Neurosurgery / Pain / Physical therapists / Physical Therapy / Population studies / Postoperative period / Recovery (Medical) / Rehabilitation / Spine (lumbar) / Subacute care / Surgical techniques / Titanium alloys / Transforaminal Lumbar Interbody Fusion