Multimodal Prehabilitation for Older Adults Undergoing Spinal Fusion : A Randomized Clinical Trial.

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.