The Impact of a Pre-Operative Spinal Education (POSE) program on post-operative length of stay following spinal fusion surgery.

Purpose

Offering psycho-educative discourse and information prior to elective lower-limb joint replacement surgery improves rehabilitative outcomes by better managing patients’ expectations. Our tertiary orthopaedic service in a large urban UK NHS Trust has found anecdotally that elective spinal surgery patients experience pre-surgery anxiety relating to expected pain and immobility, which might prolong their post-surgical hospital length-of-stay (LOS). But it remains unknown whether pre-surgical psycho-educative approaches are beneficial in minimising LOS in this patient group. The aim of this pilot study was to determine if a Pre-operative Spinal Education (POSE) programme designed to address patients’ fears and expectations following thoracic and/or lumbar spinal fusion surgery affects LOS.

Patients went home an average of 1.6 days earlier
when they participated in a pre-operative Spinal Education programme ahead of thoracic and/or lumbar spinal fusion surgery.

Approach

We conducted a pre-post Quality Improvement project, ethically approved by the local Governance Committee (ref no: 10759). The POSE programme consisted of a 60min education intervention with accompanying literature. Patient and MDT focus groups informed the content. We approached 150 consecutive patients (mean (±SD) age 56.5 ±16.7yrs, ♀︎62.0%) listed for any spinal fusion surgical procedure at 1 or more spinal level over a 10-month period. While all patients were offered POSE, some accepted (accept-POSE) and some declined (decline-POSE). A 3rd independent retrospective group represented 150 consecutive patients (57.9 ±14.8yrs, ♀︎50.6%) who underwent spinal fusion but were not offered POSE (pre-POSE) over a similar 10-month period. Mean age and gender were assessed between the 3 groups using independent-sample one-way ANOVA and Fisher’s Exact tests respectively. Post-operative LOS was assessed between the 3 groups using an independent-sample one-way ANOVA and post-hoc pairwise comparisons adjusting for age and gender. Statistical analyses were undertaken using Stata14.2 (StataCorp, TX), with ≤0.05 assumed to be statistically significant.

Outcomes

Results: All patients offered POSE proceeded to surgery. Sixty-seven (45%) patients (57.4 ±18.2 yrs, female 58.8%) accepted POSE, and 83 (55%) declined (54.9 ±15.8 yrs, ♀︎65.8%). There were no significant differences in age [=0.405], or gender [=0.074] between the three groups. While mean (95%CI) decline-POSE LOS (5.4 (4.4-6.5)days) was not significantly different to pre-POSE LOS (6.3 (5.5-7.1)days) [=0.220], accept-POSE LOS (4.7 (3.5-5.9)days) was significantly shorter than pre-POSE LOS [a mean difference of -1.6 (-3.0 to -0.17)days; =0.029].

Conclusion(s): When accepted, our POSE program was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery by over a day. In contrast, when POSE was declined mean LOS remained as if POSE was not offered. Our results are encouraging.

Cost and savings

No further data. 

Implications

A LOS reduction of 1-day not only means a reduced risk for patients unnecessarily occupying acute beds, but also equates to a cost saving per-patient of ~£382. However, it remains unclear why 55% of patients declined to participate in POSE. Nonetheless, our pilot results represent a basis to conduct further experimental work with POSE to assess its efficacy across all patients offered spinal fusion surgery, and have led to POSE being offered as standard clinical practice in our orthopaedic service.

Top three learning points

No further data.

Funding acknowledgements

Not funded