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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.).
Background:
Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery.
Objective:
To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion.
Design:
Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797).
Setting:
3 tertiary hospitals in China.
Participants:
Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025.
Intervention:
Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions.
Measurements:
The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien-Dindo classification system.
Results:
A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, -18.0% [CI, -27.0% to -9.0%]).
Limitations:
Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system.
Conclusion:
The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation.
Primary Funding Source:
Capital's Funds for Health Improvement and Research.