For patients who undergo spine surgery, an integrated program of preoperative lifestyle intervention and early rehabilitation is more cost-effective than a standard care program alone, says an article published in October 2008 on BMC Health Services Research.

The aim of the study was to assess the quality of life and to estimate the cost-effectiveness of standard care versus an integrated program including preoperative lifestyle intervention and early rehabilitation. The analyses were based on the results from 60 patients undergoing lumbar fusion for degenerative lumbar disease; 28 patients were randomly assigned to the integrated program and 32 to the standard care program. Data on cost and health-related quality of life was collected preoperatively, during hospitalization, and postoperatively. The cost was estimated from multiplication of the resource consumption and price per unit. 

Overall there was no difference in health-related quality of life scores. However, the patients from the integrated program reached their postoperative milestones sooner, returned to work, and sought less primary care after discharge. The integrated program was less costly per patient compared with the standard care program.

The preoperative program consisted of help with a regular home exercise program, pain control, a 6-week smoking cessation program with free nicotine replacement therapy, and a 4-week alcohol abstinence program with free medication, as needed.
Postoperatively, the integrated program included double the time for physical therapy during their stay at hospital, protein-rich drinks, balanced and patient-controlled epidural pain medication and a follow-up visits for smokers and harmful drinkers.