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Multimodal Prehabilitation for Older Adults Undergoing Spinal Fusion : A Randomized Clinical Trial
Shuaikang Wang1, Peng Wang1, Jun Li1
1Department of Orthopedics and Elderly Spinal Surgery, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China (S.W., P.W., J.L., D.H., Y.W., W.W., X.L., Q.W., X.C., S.L.).
Multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) significantly reduced 90-day postoperative complications in older adults undergoing spinal fusion. This approach integrated exercise, nutrition, and psychological support, improving patient outcomes in a Chinese tertiary hospital setting.
Area of Science:
- Geriatric Surgery
- Orthopedic Surgery
- Surgical Outcomes Research
Background:
- Older adults face higher risks of postoperative complications after spinal fusion due to diminished physiologic reserve.
- Effective strategies are needed to mitigate these risks and improve surgical outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of a multimodal prehabilitation program combined with Enhanced Recovery After Surgery (PREERAS) compared to ERAS alone.
- The primary objective was to assess the impact on 90-day postoperative complications in elderly patients undergoing elective spinal fusion.
Main Methods:
- A multicenter, randomized controlled trial involving 159 patients (age ≥75) undergoing elective spinal fusion.
- Participants received either PREERAS (including exercise, nutrition, psychological support) or ERAS alone for 4 weeks preoperatively.
- Postoperative complications were assessed using the Clavien-Dindo classification system within 90 days.
Main Results:
- The PREERAS group showed a significantly lower incidence of postoperative complications (74.7%) compared to the ERAS group (91.2%).
- This represents an 18% reduction in complications with a risk ratio of 0.80 (95% CI, 0.67 to 0.95).
Conclusions:
- Multimodal prehabilitation integrated with ERAS effectively reduces 90-day postoperative complications in older adults undergoing spinal fusion.
- Healthcare providers should consider the applicability and resource requirements of prehabilitation programs for this patient group.