The Effectiveness of Pulmonary Rehabilitation Applied in the Preoperative Period in Reducing Pulmonary Complications After Vertebral Body Tethering Surgery.

Abstract

Study DesignRetrospective study.ObjectivesPulmonary complications are among the most common non-mechanical adverse events following anterior vertebral body tethering (AVBT) for adolescent idiopathic scoliosis (AIS). While preoperative pulmonary rehabilitation (PPR) has been shown to reduce postoperative pulmonary complications in thoracic surgery, its role in AVBT has not been previously evaluated. This study aimed to assess the effectiveness of a standardized PPR program in reducing early postoperative pulmonary complications after AVBT.MethodsA total of 185 AIS patients who underwent primary AVBT between 2011 and 2024 were retrospectively reviewed. Patients were divided into two groups based on whether they received PPR 3 weeks preoperatively (PPR group, n = 144) or not (non-PPR group, n = 41). Pulmonary complications occurring within 6 weeks postoperatively-including pleural effusion, atelectasis, and chylothorax-were recorded. Patients were also categorized according to instrumentation level (thoracic, thoracolumbar, double major curve). Associations between PPR and pulmonary complications were analyzed using Fisher's exact test, and subgroup comparisons were performed using the Fisher-Freeman-Halton exact test.ResultsPulmonary complications occurred in 11 patients (5.9%). The complication rate was significantly lower in the PPR group compared with the non-PPR group (3.5% vs 14.6%, <i>P</i> = .016). Patients who did not receive PPR had a higher risk of pulmonary complications (risk ratio 4.21; 95% CI, 1.35-13.11). No significant differences in complication rates were observed among instrumentation subgroups (<i>P</i> = .709).ConclusionAVBT is a thoracic procedure associated with pulmonary complications, and the role of preoperative pulmonary rehabilitation (PPR) in this setting has not been previously studied. In this study, PPR was associated with a lower rate of early postoperative pulmonary complications; however, due to the retrospective time-based design, causality cannot be established. Further prospective, multicenter studies are needed to clarify its independent effect.