Physical Therapy on Postoperative Day Zero Following Spine Surgery Decreases Length of Stay
DOI:
https://doi.org/10.32469/0f8xqe05Keywords:
Anterior cervical discectomy, fusion, lumbar fusion, postoperative outcomes, physical therapy, length of stayAbstract
Abstract
Study Design: Retrospective cohort study
Objective: Postoperative LOS is a major factor in overall cost for spine surgery, and its duration often depends on discharge clearance from PT. We sought to compare postoperative length of stay (LOS) for patients who initiated physical therapy (PT) on postoperative day (POD) 0 versus POD 1 following cervical or lumbar spine surgery.
Methods: A retrospective review was conducted of 710 patients who underwent elective, inpatient >2 level anterior cervical discectomy and fusion (ACDF), >2 level posterior cervical instrumented fusion +/-laminectomy (374 cervical patients) or 1-2 level lumbar laminectomy +/-posterior fusion +/-instrumentation (336 lumbar patients) at 1 institution from 2011-2019. Patients were categorized by postoperative PT timing, with POD 0 defined within 24 hours postoperative. Patients were excluded if admitted under trauma visit, admitted to ICU before discharge for observation or complications, or had qualifying surgery >2 levels (lumbar) or <2 levels (cervical).
Results: In both surgery groups, there was no significant difference between POD 0 and POD 1 cohorts regarding: age, sex, BMI, preoperative ambulation device, discharge destination, or operative approach and fusion levels (for cervical patients) (Tables 1-2). In both groups, median LOS difference was large enough to be of statistical and clinical significance (lumbar patients 8.9 hours; cervical 25.7 hours) (P=<0.001). The difference in distribution of postoperative nights in the hospital was also significant for both POD cohorts in each group (lumbar, p=0.002; cervical, p<0.0001) (Table 3).
Conclusion: Our study demonstrated a clinically and statistically significantly lower postoperative LOS when PT was initiated within 24 hours postoperatively.
References
1. Palit M, Schofferman J, Goldthwaite N, Reynolds J, Kerner M, Keaney D, et al. Anterior discectomy and fusion for the management of neck pain. Spine (Phila Pa 1976). 1999;24(21):2224-8. doi: 10.1097/00007632-199911010-00009. PubMed PMID: 10562988.
2. Buttermann GR. Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study. Spine (Phila Pa 1976). 2018;43(3):207-14. doi: 10.1097/BRS.0000000000002273. PubMed PMID: 28604488.
3. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976). 2000;25(5):556-62. doi: 10.1097/00007632-200003010-00005. PubMed PMID: 10749631.
4. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J. 2008;8(5):747-55. Epub 20071126. doi: 10.1016/j.spinee.2007.06.013. PubMed PMID: 18037354.
5. Liu CY, Zygourakis CC, Yoon S, Kliot T, Moriates C, Ratliff J, et al. Trends in Utilization and Cost of Cervical Spine Surgery Using the National Inpatient Sample Database, 2001 to 2013. Spine (Phila Pa 1976). 2017;42(15):E906-E13. doi: 10.1097/BRS.0000000000001999. PubMed PMID: 28562473.
6. Saifi C, Fein AW, Cazzulino A, Lehman RA, Phillips FM, An HS, et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J. 2018;18(6):1022-9. Epub 20171108. doi: 10.1016/j.spinee.2017.10.072. PubMed PMID: 29128581.
7. Rihn JA, Currier BL, Phillips FM, Glassman SD, Albert TJ. Defining the value of spine care. J Am Acad Orthop Surg. 2013;21(7):419-26. doi: 10.5435/JAAOS-21-07-419. PubMed PMID: 23818029.
8. Danielsen JM, Johnsen R, Kibsgaard SK, Hellevik E. Early aggressive exercise for postoperative rehabilitation after discectomy. Spine (Phila Pa 1976). 2000;25(8):1015-20. doi: 10.1097/00007632-200004150-00017. PubMed PMID: 10767815.
9. Nielsen PR, Andreasen J, Asmussen M, Tonnesen H. Costs and quality of life for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res. 2008;8:209. Epub 20081009. doi: 10.1186/1472-6963-8-209. PubMed PMID: 18842157; PubMed Central PMCID: PMC2586633.
10. Chen AF, Stewart MK, Heyl AE, Klatt BA. Effect of immediate postoperative physical therapy on length of stay for total joint arthroplasty patients. J Arthroplasty. 2012;27(6):851-6. Epub 20120303. doi: 10.1016/j.arth.2012.01.011. PubMed PMID: 22386604.
11. Gamblin A, Garry JG, Wilde HW, Reese JC, Sherrod B, Karsy M, et al. Cost Analysis of Inpatient Rehabilitation after Spinal Injury: A Retrospective Cohort Analysis. Cureus. 2019;11(9):e5747. Epub 20190924. doi: 10.7759/cureus.5747. PubMed PMID: 31723508; PubMed Central PMCID: PMC6825436.
12. Larsen K, Sorensen OG, Hansen TB, Thomsen PB, Soballe K. Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop. 2008;79(2):149-59. doi: 10.1080/17453670710014923. PubMed PMID: 18478482.
13. Larsen K, Hansen TB, Thomsen PB, Christiansen T, Soballe K. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Joint Surg Am. 2009;91(4):761-72. doi: 10.2106/JBJS.G.01472. PubMed PMID: 19339559.
14. den Hertog A, Gliesche K, Timm J, Muhlbauer B, Zebrowski S. Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay. Arch Orthop Trauma Surg. 2012;132(8):1153-63. Epub 20120527. doi: 10.1007/s00402-012-1528-1. PubMed PMID: 22643801; PubMed Central PMCID: PMC3400756.
15. Smith TO, McCabe C, Lister S, Christie SP, Cross J. Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty. Orthop Traumatol Surg Res. 2012;98(5):499-505. Epub 20120715. doi: 10.1016/j.otsr.2012.03.005. PubMed PMID: 22796251.
16. Bohl DD, Li J, Calkins TE, Darrith B, Edmiston TA, Nam D, et al. Physical Therapy on Postoperative Day Zero Following Total Knee Arthroplasty: A Randomized, Controlled Trial of 394 Patients. J Arthroplasty. 2019;34(7S):S173-S7 e1. Epub 20190213. doi: 10.1016/j.arth.2019.02.010. PubMed PMID: 30827716.
17. Low M, Burgess LC, Wainwright TW. A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery. Medicina (Kaunas). 2019;55(7). Epub 20190707. doi: 10.3390/medicina55070347. PubMed PMID: 31284666; PubMed Central PMCID: PMC6681378.
18. Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D. A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J. 2007;16(8):1101-17. Epub 20070626. doi: 10.1007/s00586-007-0399-6. PubMed PMID: 17593405; PubMed Central PMCID: PMC2200780.
19. Richardson CA, Jull GA. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995;1(1):2-10. doi: 10.1054/math.1995.0243. PubMed PMID: 11327788.
20. Madera M, Brady J, Deily S, McGinty T, Moroz L, Singh D, et al. The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review. J Neurosurg Spine. 2017;26(6):694-704. Epub 20170310. doi: 10.3171/2016.10.SPINE16627. PubMed PMID: 28291412.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Daniel Hogan, Blaine Manning, Suryanshi Rawat, Haley Huff, Shelby Harris, Stefan Hanish, Nathan Cherian, Emily Leary, Theodore Choma, Don Moore
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
