Beneficial Effects of Preoperative Exercise on the Outcomes of Lumbar Fusion Spinal Surgery

May 31, 2023

. 2023 Feb 8;75(1):22-28.

doi: 10.3138/ptc-2021-0030.

eCollection 2023 Winter.

Denise C Lawrence¹, Amanallah Montazeripouragha², Eugene K Wai^{1

3

4

5}, Darren M Roffey^{1

5}, Kim M Phan¹, Philippe Phan^{1

3}, Alexandra Stratton^{1

3}, Stephen Kingwell^{1

3}, Greg McIntosh⁶, Alex Soroceanu⁷, Edward Abraham⁸, Christopher S Bailey⁹, Sean Christie¹⁰, Jerome Paquet¹¹, Andrew Glennie¹², Andrew Nataraj¹³, Hamilton Hall¹⁴, Charles Fisher¹⁵, Y Raja Rampersaud¹⁶, Kenneth Thomas⁷, Neil Manson⁸, Michael Johnson², Mohammad Zarrabian²

Affiliations

¹ The Ottawa Hospital, Ottawa, Ontario, Canada.
² Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
⁴ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
⁶ Research Operations, Canadian Spine Outcomes Research Network, Markdale, Ontario, Canada.
⁷ University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
⁸ Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada.
⁹ Lawson Health Research Institute/London Health Sciences Centre, Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada.
¹⁰ Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Hôpital de l’Enfant-Jésus, Laval University, Quebec City, Quebec, Canada.
¹² Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia, Canada.
¹³ University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Arthritis Program, Krembil Research Institute, University Health Network, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.

Item in Clipboard

Denise C Lawrence et al.

Physiother Can.

2023.

. 2023 Feb 8;75(1):22-28.

doi: 10.3138/ptc-2021-0030.

eCollection 2023 Winter.

Authors

Affiliations

¹ The Ottawa Hospital, Ottawa, Ontario, Canada.
² Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.
⁴ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
⁶ Research Operations, Canadian Spine Outcomes Research Network, Markdale, Ontario, Canada.
⁷ University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
⁸ Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada.
⁹ Lawson Health Research Institute/London Health Sciences Centre, Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada.
¹⁰ Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada.
¹¹ Hôpital de l’Enfant-Jésus, Laval University, Quebec City, Quebec, Canada.
¹² Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia, Canada.
¹³ University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁶ Arthritis Program, Krembil Research Institute, University Health Network, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.

Item in Clipboard

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.

Objectif : déterminer s’il y avait une association entre les exercices préopératoires autodéclarés et les résultats postopératoires après une chirurgie de fusion lombaire. Méthodologie : analyse multivariable rétrospective de la base de données prospective Canadian Spine Outcomes and Research Network (CSORN) composée de 2 203 patients qui avaient subi une chirurgie de fusion lombaire univertébrale non urgente. Les chercheurs ont comparé les événements indésirables et la durée du séjour hospitalier entre les patients qui déclaraient faire de l’exercice régulier (au moins deux fois par semaine) avant l’opération (« exercice régulier ») à ceux qui n’en faisaient pas souvent (une fois ou moins par semaine; « exercice peu fréquent ») et qui n’en faisaient pas du tout (« absence d’exercice »). Pour toutes les analyses définitives, ils ont comparé le groupe qui faisait de l’exercice régulier aux groupes combinés d’exercice peu fréquent et d’absence d’exercice. Résultats : après correction pour tenir compte des facteurs confusionnels connus, les chercheurs ont démontré que les patients du groupe faisant de l’exercice régulier présentaient moins d’événements indésirables (rapport de cotes rajusté 0,72; IC à 95 % : 0,57, 0,91; p = 0,006) et leur séjour à l’hôpital était significativement plus court (moyenne corrigée 2,2 jours par rapport à 2,5 jours, p = 0,029) que dans le groupe combiné d’exercice peu fréquent et d’absence d’exercice. Conclusions : les patients qui faisaient de l’exercice régulièrement au moins deux fois par semaine avant l’opération présentaient moins d’événements indésirables après l’opération et étaient hospitalisés beaucoup moins longtemps que ceux qui ne faisaient pas beaucoup d’exercice ou n’en faisaient pas du tout. Il faudra réaliser d’autres études pour déterminer l’efficacité d’un programme de préréadaptation ciblé.

Keywords:

exercise; orthopedic procedures; retrospective studies; risk factors; spine.