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

Document Type

Conference Proceeding

Publication Date


Publication Title

Spine J


BACKGROUND CONTEXT: With a lesser degree of tissue destruction and lower postoperative opiate burden, patients undergoing minimally-invasive spine surgery are primed to benefit from early mobilization, which can further enhance recovery and hasten rehabilitation after surgery. PURPOSE: To determine the role of physical therapy on earlier postoperative discharge after minimally-invasive transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING: Cohort study. PATIENT SAMPLE: All patients undergoing one- and two-level minimally-invasive TLIF for degenerative lumbar diseases were operated on by the senior author from January 1, 2016 until August 31, 2018. Demographic data, comorbidities, preoperative patient-reported outcomes (PROs), intraoperative parameters, and postoperative measures were abstracted from a prospectively maintained database, ie, Michigan Spine Surgery Improvement Collaborative (MSSIC). Data on ambulation were collected from the physical therapy notes. OUTCOME MEASURES: The primary outcome measure is postoperative length of acute care stay. Length of stay was divided into (1) discharge on postoperative day 1 (POD 1 cohort), (2) discharge on postoperative day 2 (POD 2 cohort), and (3) discharge on ≥3 postoperative days (POD ≥3 cohorts) to maintain three equal-time cohorts. METHODS: An ordinal logistic regression model was fitted to the data to estimate the effect of discharge on postoperative day 1 vs postoperative day 2 vs postoperative ≥ day 3. Anesthesiology (ASA) classification was used as a surrogate marker of comorbidity burden. RESULTS: Of the 90 patients, the day of first ambulation with physical therapy increased from a mean of 14.4 ± 9.6 hours after surgery in the POD 1 cohort, 19.2 ± 7.2 hours in the POD 2 cohort, to 24.0 ± 12.0 hours in the POD ≥3 cohort (p=0.009). Furthermore, mean distance ambulated upon first interaction with physical therapy decreased from 162.8 ± 127.5 feet in the POD 1 group, 111.2 ± 83.6 feet in the POD 2 group, to 58.7 ± 59.3 feet in the POD ≥3 group (p<0.001). The three cohorts did not differ in baseline (preoperative) PROs: Oswestry Disability Index, EQ-5D, Numeric Rating Scale–Back Pain, and Numeric Rating Scale–Leg Pain. Following a multivariable ordinal logistical regression controlling for disposition to rehab over home (ORadj=6.07, p=0.029), the odds of longer length of stay decreased by 35% for every 50-feet ambulated (p=0.014). Preoperative Oswestry Disability Index failed to predict day of discharge (ORadj=1.01, p=0.146). CONCLUSIONS: Time to first ambulation with a therapist independently increases the odds of earlier discharge. Regardless of preoperative patient-reported outcomes, ambulation remains a stronger predictor of discharge. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.





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