Traditional Korean Rehabilitation Medicine and Long-Term Health Outcomes after Lumbar Spine Surgery: A Nationwide Propensity-Matched Cohort Study.

Abstract

Introduction: Unplanned readmission, institutionalization, and early mortality remain common after lumbar spine surgery, especially in older adults. Traditional Korean rehabilitation medicine (TKRM) is widely used in Korea, yet its long-term impact on postoperative outcomes has not been clarified.

Methods: In this nationwide, retrospective cohort study, National Health Insurance Service claims data from 2019 to 2021 were used to identify 30,022 adults discharged after lumbar surgery. Propensity-score matching (1:1) produced 11,938 comparable patients who either received TKRM within 6 months of discharge or usual care alone. Cox proportional-hazards models estimated adjusted hazard ratio (aHRs) for readmission, entry into long-term care, and all-cause mortality over 6-24 months; dose-response effects were examined across quartiles of cumulative TKRM visits, and diagnosis-specific subgroup analyses contrasted intervertebral disc disorders with spinal stenosis.

Results: Early TKRM use was associated with significantly lower risks of readmission (aHR 0.49; 95% confidence interval 0.32-0.75), entry into long-term care (0.36; 0.21-0.62), and mortality (0.49; 0.32-0.75). A graded inverse relationship was observed: patients in the highest exposure quartile showed the greatest benefit (aHR for readmission: 0.24; long-term care facility: 0.12; mortality: 0.16). Protective effects were most pronounced in intervertebral disc disorders, whereas reductions in readmission did not reach significance for spinal stenosis.

Conclusions: Utilization of TKRM within the first six postoperative months is associated with sustained reductions in unplanned readmission, entry into long-term care, and all-cause mortality after lumbar surgery, with a clear dose-response relationship. These findings suggest that early TKRM use may be associated with improved postoperative outcomes following lumbar surgery, although further research is needed to confirm these associations.