Day one versus day zero postoperative physical therapy among patients with lumbar spinal fusion: a length of stay comparison

BACKGROUND CONTEXT Postoperative physical therapy (PT) following lumbar spinal fusion is an effective form of postoperative rehabilitation. However, it is unknown when a postoperative PT protocol should be optimally initiated. PURPOSE This study sought to compare lengths of stay between patients on a day zero PT protocol and those on a day one PT protocol. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Patients who underwent lumbar spinal surgery at a large midwestern tertiary medical care center from January 1, 2018 through April 30, 2019 were eligible for their medical record's inclusion. PRIMARY OUTCOME MEASURE Length of hospital stay following surgery. METHODS Patients were stratified by having started postoperative PT on the same day as surgery (day zero) or having started postoperative PT on the day following surgery (day one). RESULTS A total of 164 patients were included in the study, 69 in the day zero group and 95 patients in the day one group. Most patients were female (59%, n = 98), and patients’ average age was 62 years (SD = 13). Average length of stay was 61 hours (SD = 20) for those on the day zero protocol and 75 hours (SD = 32) for those on the day one protocol. CONCLUSIONS This study suggests that a postoperative physical therapy protocol initiated on day zero is associated with patients experiencing a shorter length of hospital stay compared to a similar PT protocol initiated on postoperative day one.