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

Summary

In a multicenter, assessor-blinded RCT of adults ≥75 years undergoing elective spinal fusion, adding a 4-week multimodal prehabilitation to ERAS reduced 90-day postoperative complications compared with ERAS alone (RR 0.80; risk difference −18%). The program combined supervised multicomponent exercise, nutritional optimization, and psychological support.

Key Findings

• PREERAS reduced any 90-day postoperative complication vs ERAS alone: 74.7% vs 91.2% (RR 0.80, 95% CI 0.67–0.95; risk difference −18%).
• Intervention: 4-week supervised multicomponent exercise (Vivifrail), nutritional optimization, and psychological support.
• Design: Multicenter, open-label, assessor-blinded RCT; mean age 78.7 years; 59% women.

Clinical Implications

Consider multidisciplinary prehabilitation (exercise, nutrition, psychology) for older adults before elective spinal fusion within ERAS pathways; resource needs and local feasibility should be assessed.

Limitations

• Open-label to participants and clinicians, introducing potential performance bias.
• Generalizability may be limited due to longer hospital stays and care pathways in the Chinese system.

Future Directions

Cost-effectiveness analyses, scalability across diverse health systems, and identification of responder phenotypes (e.g., frailty, sarcopenia) are warranted.