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Kwan WC, Ailon T, Dea N, Evaniew N, Rampersaud R, Jacobs BW, Paquet J, Wilson JR, Hall H, Bailey CS, Weber MH, Nataraj A, Cadotte YDW, Phan P, Christie SD, Fisher CG, Singh S, Manson N, Thomas KC, Toor J, Soroceanu A, McIntosh G, Charest-Morin R. Satisfaction in Surgically Treated Patients with Degenerative Cervical Myelopathy: An observational study from the Canadian Spine Outcomes and Research Network. Spine J 2024:S1529-9430(24)01044-1. [PMID: 39341576 DOI: 10.1016/j.spinee.2024.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND CONTEXT Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established. PURPOSE Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM. DESIGN This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN). PATIENT SAMPLE Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021. OUTCOME MEASURES Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale. METHODS Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups. RESULTS Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, -3%, -10%, -14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI = 0.81 - 0.90). No patient demographic or surgical factors influenced satisfaction. CONCLUSION Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.
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Affiliation(s)
- William Chu Kwan
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Evaniew
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bradley W Jacobs
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Jérome Paquet
- Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, Quebec, Canada
| | - Jefferson R Wilson
- Divisions of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher S Bailey
- Department of Orthopedics Surgery, London Health Science Centre, Western University, London, Ontario, Canada
| | - Michael H Weber
- Department of Orthopedics Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Y David W Cadotte
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Philippe Phan
- Department of Orthopedics Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Supriya Singh
- Department of Orthopedics Surgery, London Health Science Centre, Western University, London, Ontario, Canada
| | - Neil Manson
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kenneth C Thomas
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Jay Toor
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alex Soroceanu
- Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Morales A, El Chamaa A, Mehta S, Rushton A, Battié MC. Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:851-871. [PMID: 37917206 DOI: 10.1007/s00586-023-08002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS. METHODS Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes. RESULTS Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16-1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity. CONCLUSION Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research.
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Affiliation(s)
- Ariel Morales
- School of Physical Therapy, Western University, London, ON, Canada
| | - Alaa El Chamaa
- School of Physical Therapy, Western University, London, ON, Canada
| | - Swati Mehta
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada
| | - Michele C Battié
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada.
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Wagener N, Löchel J, Hipfl C, Perka C, Hardt S, Leopold VJ. Psychological status affects postoperative quality of life, function, and pain after periacetabular osteotomy. Bone Jt Open 2023; 4:758-765. [PMID: 37821094 PMCID: PMC10567161 DOI: 10.1302/2633-1462.410.bjo-2023-0104.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Aims Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO. Methods In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis. Results In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001). Conclusion Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected.
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Affiliation(s)
- Nele Wagener
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Jannis Löchel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Vincent J. Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
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Correlation of mental health with physical function, pain, and disability following anterior lumbar interbody fusion. Acta Neurochir (Wien) 2023; 165:341-349. [PMID: 36629953 DOI: 10.1007/s00701-022-05459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/10/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Studies have demonstrated the influence of preoperative mental health on outcomes following spine surgery, but prior literature has not assessed the influence of mental health at time of outcome survey collection. METHODS Patients who underwent elective anterior lumbar interbody fusion (ALIF) were identified from a prospective registry. Patient-reported outcomes (PROs) were collected preoperatively and up to 1 year postoperatively. Mental health measures studied included 12-item Short Form (SF-12) Mental Component Score (MCS) and Patient Health Questionnaire-9 (PHQ-9). Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) were compared to the mental health measures by Pearson's correlation tests. RESULTS A total of 166 patients were included. SF-12 MCS demonstrated positive correlation to PROMIS-PF preoperatively (|r|= 0.379) and at 6 weeks (|r|= 0.387) (p ≤ 0.016, all). SF-12 MCS demonstrated negative correlation to VAS back at 6 months (|r|= 0.359), VAS leg at 6 weeks (|r|= 0.475) and 12 weeks (|r|= 0.422), and ODI up to 6 months postoperatively (|r|= 0.417-0.526) (p ≤ 0.037, all). PHQ-9 negatively correlated with PROMIS-PF at all periods studied (|r|= 0.425-0.587) and SF-12 PCS up to 6 months postoperatively (|r|= 0.367-0.642) (p ≤ 0.016, all). PHQ-9 positively correlated to VAS back at 6 weeks (|r|= 0.408) and 6 months (|r|= 0.411), VAS leg at 6 weeks (|r|= 0.344), and ODI up to 6 months postoperatively (|r|= 0.321-0.669) (p ≤ 0.034, all). CONCLUSION Inferior mental health correlated with inferior pain, function, and disability scores at one or more periods postoperatively. This finding was most consistent for correlation between mental health scores and disability. Optimization of mental health may positively influence outcomes, especially regarding disability, following ALIF.
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Rahman R, Zhang B, Andrade NS, Ibaseta A, Kebaish KM, Riley LH, Cohen DB, Jain A, Lee SH, Sciubba DM, Skolasky RL, Neuman BJ. Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients. Clin Spine Surg 2021; 34:E588-E593. [PMID: 33298800 PMCID: PMC8184861 DOI: 10.1097/bsd.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients. SUMMARY OF BACKGROUND DATA Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction. MATERIALS AND METHODS Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12 months postoperatively using Patient-Reported Outcomes Measurement Information System Depression and Anxiety scores. Satisfaction was assessed 12 months postoperatively using North American Spine Society Patient Satisfaction Index. The authors evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05. RESULTS A total of 183 patients (47% male individuals; avg. age, 62 y) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. Ninteen percent reported postoperative dissatisfaction using the North American Spine Society Patient Satisfaction Index. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio=6.1; 95% confidence interval, 1.2-32; P=0.03) and moderate or severe postoperative depression (adjusted odds ratio=7.5; 95% confidence interval, 1.3-52; P=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction. CONCLUSIONS Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Rafa Rahman
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Zhang
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas S. Andrade
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvaro Ibaseta
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khaled M. Kebaish
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lee H. Riley
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David B. Cohen
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amit Jain
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sang H. Lee
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M. Sciubba
- Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L. Skolasky
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J. Neuman
- Departments of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bays A, Stieger A, Held U, Hofer LJ, Rasmussen-Barr E, Brunner F, Steurer J, Wertli MM. The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 6:100072. [PMID: 35141637 PMCID: PMC8820012 DOI: 10.1016/j.xnsj.2021.100072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) affects mainly elderly patients. To this day, it is unclear whether comorbidities influence treatment success. The aim of this systematic review and meta-analysis was to assess the impact of comorbidities on the treatment effectiveness in symptomatic LSS. METHODS We conducted a systematic review and meta-analysis and reviewed prospective or retrospective studies from Medline, Embase, Cochrane Library and CINAHL from inception to May 2020, including adult patients with LSS undergoing surgical or conservative treatment. Main outcomes were satisfaction, functional and symptoms improvement, and adverse events (AE). Proportions of outcomes within two subgroups of a comorbidity were compared with risk ratio (RR) as summary measure. Availability of ≥3 studies for the same subgroup and outcome was required for meta-analysis. RESULTS Of 72 publications, 51 studies, mostly assessing surgery, there was no evidence reported that patients with comorbidities were less satisfied compared to patients without comorbidities (RR 1.06, 95% confidence interval (CI) 0.77 to 1.45, I 2 94%), but they had an increased risk for AE (RR 1.46, 95% CI 1.06 to 2.01, I 2 72%). A limited number of studies found no influence of comorbidities on functional and symptoms improvement. Older age did not affect satisfaction, symptoms and functional improvement, and AE (age >80 years RR 1.22, 95% CI 0.98 to 1.52, I 2 60%). Diabetes was associated with more AE (RR 1.72, 95% CI 1.19 to 2.47, I 2 58%). CONCLUSION In patients with LSS and comorbidities (in particular diabetes), a higher risk for AE should be considered in the treatment decision. Older age alone was not associated with an increased risk for AE, less functional and symptoms improvement, and less treatment satisfaction.
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Affiliation(s)
- Amandine Bays
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Andrea Stieger
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Lisa J Hofer
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Eva Rasmussen-Barr
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Huddinge, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden
| | - Florian Brunner
- Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Johann Steurer
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, University Hospital of Bern, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
- Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse 24, 8032 Zurich, Switzerland
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Goh GS, Liow MHL, Yue WM, Tan SB, Chen JLT. Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health? Global Spine J 2021; 11:500-508. [PMID: 32875869 PMCID: PMC8119908 DOI: 10.1177/2192568220912712] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN This was a retrospective review of prospectively collected data. OBJECTIVES Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups. METHODS Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years. RESULTS Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively (P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months (P = .353). The low MCS group had poorer satisfaction (P = .022) and expectation fulfilment (P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months (P = .034), but the rates converged from 6 months onward. CONCLUSIONS Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.
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Affiliation(s)
- Graham S. Goh
- Singapore General Hospital, Singapore,Graham S. Goh, Department of Orthopaedic
Surgery, Singapore General Hospital, Singapore 557891, Singapore.
| | | | - Wai-Mun Yue
- Mount Elizabeth Medical Centre, General Hospital, Singapore
| | - Seang-Beng Tan
- Mount Elizabeth Medical Centre, General Hospital, Singapore
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Predictors of Outcomes After Single-level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy: A Multivariate Analysis. Clin Spine Surg 2020; 33:E525-E532. [PMID: 32349058 DOI: 10.1097/bsd.0000000000000997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN This was a retrospective study that was carried out using prospectively collected registry data. OBJECTIVE The objective of this study was to identify preoperative predictors of outcomes after anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA Proper patient selection is paramount to achieving good surgical results. Identifying predictors of outcomes may aid surgical decision-making and facilitate counseling of patients to manage expectations. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Outcomes assessed at 2 years were the presence of residual neck pain/arm pain (AP), and attainment of a minimal clinically important difference (MCID) for Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and Physical Component Score (PCS) of SF-36, as well as patient satisfaction, fulfilment of expectations, willingness to undergo same surgery again, return to work (RTW), and return to function (RTF). Receiver operating characteristic curves and multivariate stepwise logistical regression were performed to identify independent predictors of each outcome using 22 covariates including demographics, comorbidities, and preoperative disease state. RESULTS Lower preoperative NDI was predictive of the absence of residual neck pain/AP at 2 years. Higher preoperative JOA score was predictive of MCID attainment for PCS, satisfaction, expectation fulfilment, willingness to undergo the same surgery for same condition, and RTF. Poorer preoperative scores of NDI, JOA, and PCS were predictors of attaining MCID of the respective scores. Older patients were less likely to attain MCID for JOA. Higher preoperative AP was a risk factor for unsuccessful RTW. CONCLUSIONS In general, the preoperative JOA score was the best predictor of outcomes after ACDF. A preoperative JOA cutoff value of 9.25-10.25 predicted satisfaction, expectation fulfilment, willingness to undergo same surgery, and RTF with at least 70% sensitivity and 50% specificity. These findings may aid surgeons in identifying patients at risk of a poor outcome and guide preoperative counseling to establish realistic expectations of the surgical outcome. LEVEL OF EVIDENCE Level III-Non-randomized controlled cohort/follow-up study.
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Patient-Reported Expectations, Outcome and Satisfaction in Thoracic and Lumbar Spine Stabilization Surgery: A Prospective Study. SURGERIES 2020. [DOI: 10.3390/surgeries1020008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patient-reported outcome measures (PROMs) have become an important aspect of quality control in modern healthcare. In this prospective observational study on 199 patients undergoing thoracolumbar stabilization surgery, we quantified preoperative expectations and PROMs at six and twelve months after surgery, and we investigated what constitutes patient satisfaction with the outcome. We used the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI). Preoperative expectations were high (expected ODI: 9 ± 13%; leg pain: 1.0 ± 1.4; back pain: 1.3 ± 1.5). Pain and disability improved substantially, but expectations were mostly unrealistic (ODI expectation fulfilled after six months: 28% of patients; back pain: 48%). However, satisfaction was high (70% at six months after surgery). Satisfied patients had significantly better pain and disability outcomes and higher rates of expectation fulfillment than non-satisfied patients. Patients undergoing revision stabilization had worse outcomes than all other diagnosis groups. Prior stabilization surgery was identified as an independent risk factor for dissatisfaction. There were no preoperative pain or disability levels that predicted dissatisfaction. The data presented in this study can provide benchmarks for diagnosis-specific PROM targets in thoracolumbar stabilization surgery. Future studies should investigate whether satisfaction can be influenced, e.g., by discussing realistic outcome targets with patients ahead of surgery.
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Sivaganesan A, Khan I, Pennings JS, Roth SG, Nolan ER, Oleisky ER, Asher AL, Bydon M, Devin CJ, Archer KR. Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful? Spine J 2020; 20:1535-1543. [PMID: 32544721 DOI: 10.1016/j.spinee.2020.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Studies have found that most patients are satisfied after spine surgery, with rates ranging from 53% to 90%. Patient satisfaction appears to be closely related to achieving clinical improvement in pain and disability after surgery. While the majority of the literature has focused on patients who report both satisfaction and clinical improvement in disability and pain, there remains an important subpopulation of patients who have clinically relevant improvement but report being dissatisfied with surgery. PURPOSE To examine why patients who achieve clinical improvement in disability or pain also report dissatisfaction at 1-year after spinal surgery. STUDY DESIGN Retrospective analysis of prospective data from a national spine registry, the Quality Outcomes Database. PATIENT SAMPLE There were 34,076 participants undergoing elective surgery for degenerative spine pathology who had clinical improvement in disability or pain. OUTCOME MEASURES Satisfaction with surgery was assessed with 1-item from the North American Spine Society lumbar spine outcome assessment. Participants with answer choices other than "treatment met my expectations" were classified as dissatisfied. METHODS Patients completed a baseline and 12-month postoperative assessment to evaluate disability, pain, and satisfaction. Clinical improvement was defined as patients who achieved a 30% or greater improvement in spine-related disability (Oswestry/Neck Disability Index) or extremity pain (11-point Numeric Rating Scale) from baseline to 12-month after surgery. A generalized linear mixed model was used to predict the odds of the patient being dissatisfied 1-year after surgery from demographic, clinical and surgical characteristics, postoperative complications and revision, and return to work and previous physical activity. Random effects were included to model the effect of both site and surgeon on dissatisfaction. Sensitivity analyses were conducted on samples who achieved 30% or greater improvement in (1) disability only, (2) axial (back/neck) pain only, (3) extremity (leg/arm)pain only, (4) both disability and axial pain, and (5) both disability and extremity pain. Results showed the same pattern of findings across all samples. RESULTS Twenty-eight percent of patients were classified as dissatisfied with their spine surgery and 72% classified as satisfied. For patients with clinical improvement in disability or extremity pain at 1-year, significant predictors of higher odds of dissatisfaction included baseline psychological distress, current smoking status, workers compensation claim, lower education, higher ASA grade, lumbar versus cervical procedure, and increased axial pain, major complication within 30 days, and revision surgery within 12-months. The most important contributors to dissatisfaction were return to work and return to previous physical activity, with the odds of dissatisfaction being over 2 times and 4 times higher for these variables. Site and surgeon explained 3.8% of the variance in dissatisfaction, with more of the variance attributed to site than to surgeon. CONCLUSIONS Several modifiable factors, including psychological distress, current smoking status, and failure to return to work and physical activity, helped explain why patients report being dissatisfied with surgery despite clinical improvement in disability or pain. The findings of this study have the potential to help providers identify at-risk patients, set realistic expectations during preoperative counseling, and implement postoperative management strategies. A multidisciplinary approach to rehabilitation that includes functional goal setting or restoration may help to improve patients psychological distress as well as return to work and previous physical activity after spine surgery.
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Affiliation(s)
- Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Inamullah Khan
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth R Nolan
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily R Oleisky
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony L Asher
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Preoperative psychological factors affecting surgical satisfaction of elderly patients with lumbar spinal stenosis. J Orthop Sci 2020; 25:751-756. [PMID: 31806423 DOI: 10.1016/j.jos.2019.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 09/05/2019] [Accepted: 10/01/2019] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The objective of this observational study was to investigate the effects of preoperative psychological factors on short-term patient satisfaction with surgery in elderly patients with lumbar spinal stenosis (LSS). METHODS Surgery was performed on 90 elderly patients with clinically and radiologically defined LSS: mean age at surgery, 73 years; 46 men and 44 women. Patients completed questionnaires before surgery and 1 year postoperatively. They used a self-administered the Roland Morris Disability Questionnaire (RDQ), the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), MOS 36-Item Short-Form Health Survey (SF-36), and satisfaction for surgery (VAS) were completed. At baseline, psychological factors were assessed using the Self-Rating Questionnaire for Depression (SRQ-D), Hospital Anxiety and Depression scale (HADS), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale-20, and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP). At follow-up, patient satisfaction was evaluated using 2 items: (1) satisfaction with surgery and (2) Would you undergo the same surgery again?. RESULTS Satisfaction item 1 correlated negatively with the VAS for low back pain, leg pain, numbness, JOABPEQ social life disturbance score, SF-36 physical function score, and HADS anxiety score (p < 0.05). Satisfaction 2 correlated negatively with age at surgery, VAS of leg pain, PCS magnification score, and BS-POP score (p < 0.05). Multiple regression analysis showed significant associations between satisfaction 1 and SF-36 physical function and HADS anxiety scores, and between satisfaction 2 and PCS magnification score (p < 0.05). STATISTICAL ANALYSIS The preoperative factors independently associated with surgical satisfaction were analyzed utilizing Speaman's rank correlation coefficient and multiple regression analysis. CONCLUSION Physical function and anxiety were identified as preoperative factors that affected patient satisfaction with surgery. Preoperative assessment of psychological factors and interventions for anxiety may help improve patient satisfaction after surgery for LSS.
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Unfolding the outcomes of surgical treatment of lumbar spinal stenosis—a prospective 5- and 10-year follow-up study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2231-2242. [DOI: 10.1007/s00586-020-06424-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/25/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose
In this prospective study, we aim to determine surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery.
Methods
The study population consisted of 96 LSS patients who underwent decompressive surgery, 72 of whom participated in the 10-year follow-up. The patients completed a questionnaire preoperatively and 3 months, 5 years, and 10 years postoperatively. Outcome measures were satisfaction with the surgical outcomes, the Oswestry Disability Index (ODI), the visual analog scale (VAS), the numeric rating scale (NRS-11), and walking ability quantified in meters. Postoperative improvements at 5 and 10 years were analyzed using linear mixed models. Furthermore, comparisons between postoperative time points were made for clinical courses of pain, disability, and walking ability.
Results
At the 10-year follow-up, 68% of the patients were satisfied with the surgical outcomes. All the measured outcomes showed statistically significant improvement from baseline to the 5- and 10-year follow-up. The mean VAS score was 9.8 mm higher at the 5-year follow-up and 7.8 mm at the 10-year follow-up compared to the 3-month follow-up point. Similarly, the mean ODI was 4.8% higher at the 10-year follow-up compared to the 3-month follow-up point.
Conclusion
This study reports the clinical course of pain, disability, and walking distance after LSS surgery with the 10-year follow-up. Based on our study results, patients with LSS could expect to have positive effects of their back surgery up to 10 years. However, minor worsening in pain and disability may occur and one-fourth of the patients may need a reoperation during the 10-year follow-up period.
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Menendez JY, Omar NB, Chagoya G, Tabibian BE, Elsayed GA, Walters BC, Guthrie BL, Hadley MN. Patient Satisfaction in Spine Surgery: A Systematic Review of the Literature. Asian Spine J 2019; 13:1047-1057. [PMID: 31352720 PMCID: PMC6894977 DOI: 10.31616/asj.2019.0032] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 12/03/2022] Open
Abstract
Patient satisfaction reflects the patients' perception of the outcome of care and is being considered for use in future reimbursement schemes. No consensus exists regarding the best instrument to measure patient satisfaction in the field of spine surgery. This systematic review aimed to determine how patient satisfaction for spine surgery has been measured previously and whether a disease-specific, comprehensive instrument to measure patient satisfaction has been established; we also aimed to define the dimensions of care that determine patient satisfaction in spine surgery. A systematic search of three online databases, unpublished sources, and citations was undertaken to identify 156 empirical studies that reported on patient satisfaction in the field of spine surgery. Manuscripts were reviewed in terms of the patient satisfaction instrument used, and the instruments were categorized as per content and method axes. Taxonomy of patient satisfaction with spine surgery identified the major characteristics of providers and medical care that influenced patient satisfaction and acted as a structure to categorically define the dimensions of patient satisfaction in spine surgery. The reviewed studies predominantly used global (108/156) rather than multidimensional (46/156), instruments. Most studies (96.2%) reported satisfaction with outcome rather than with care, and only 18.5% of the studies (29/156) utilized a disease-specific instrument. The following seven dimensions of patient status, outcome, and care experience that affected patient satisfaction were identified: pain, function, patient expectations/preference, specific patient health characteristics, caregiver interpersonal manner, efficacy/clinical outcomes, and postoperative care/therapy. Currently, no disease-specific instrument that includes all dimensions of patient satisfaction in spine surgery has been developed. Such a patient satisfaction instrument should be designed, tested for reliability and validity, and widely implemented.
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Affiliation(s)
- Joshua York Menendez
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nidal Bassam Omar
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Borna Ethan Tabibian
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Galal Ashraf Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Barton Lucius Guthrie
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Norman Hadley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2019; 44:839-847. [PMID: 30540718 DOI: 10.1097/brs.0000000000002960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study using prospectively collected registry data. OBJECTIVE The authors examine the influence of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) and determine the impact of ACDF on postoperative mental health. SUMMARY OF BACKGROUND DATA While studies have reported a negative correlation between preoperative mental health and outcomes following lumbar spine surgery, the influence on outcomes following cervical spine surgery remains relatively understudied. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Patients were dichotomized into top and bottom halves based on preoperative SF-36 MCS (Mental Component Summary) using a cutoff of 48. Outcomes assessed were visual analogue scale for neck pain, arm pain, AAOS Neck Pain and Disability, Neurogenic Symptoms, Neck Disability Index, Short-Form 36, Japanese Orthopaedic Association myelopathy score, return to work, return to function, satisfaction and expectation fulfilment up to 2 years postoperatively. RESULTS The preoperative MCS was 37.5 ± 8.1 and 57.4 ± 6.3 in the Low and High MCS groups respectively (P < 0.001). The Low MCS group had poorer preoperative scores (P < 0.05). There was no significant difference in length of stay or comorbidities (P > 0.05). The High MCS group had less neck pain (P = 0.002) and showed a trend towards lower Neck Disability Index (P = 0.062) at 2 years. The Low MCS group demonstrated greater improvement in Japanese Orthopaedic Association (P = 0.007) and similar improvement in other scores (P > 0.05). There was no significant difference in proportion that achieved minimal clinically important difference for each score (P > 0.05). Both groups had similar rates of return to work, return to function, expectation fulfilment, and satisfaction (P > 0.05). Lower preoperative MCS was predictive of greater improvement in MCS (r = -0.477, P < 0.001). CONCLUSION Despite relatively greater pain and disability at 2 years, patients with poor baseline mental health experienced similar improvement in clinical outcomes, return to work, and satisfaction rates. LEVEL OF EVIDENCE 3.
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Diebo BG, Segreto FA, Jalai CM, Vasquez-Montes D, Bortz CA, Horn SR, Frangella NJ, Egers MI, Klineberg E, Lafage R, Lafage V, Schwab F, Passias PG. Baseline mental status predicts happy patients after operative or non-operative treatment of adult spinal deformity. JOURNAL OF SPINE SURGERY 2018; 4:687-695. [PMID: 30713999 DOI: 10.21037/jss.2018.09.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The study is a retrospective review of a multi-institutional database, aiming to determine predictors of non-depressed, satisfied adult spinal deformity (ASD) patients with good self-image at 2-year follow-up (2Y). ASD significantly impacts a patients' psychological status. Following treatment, little is known about predictors of satisfied patients with high self-image and mental status. Methods Inclusion: primary ASD pts >18 y/o with complete 2Y follow-up. Non-depressed [Short Form 36-mental component score (SF36-MCS) >42], satisfied patients (SRS22-satisfaction >3) with good self-image (SR22-self-image >3) at 2Y were isolated (happy). Happy and control patients were propensity-matched by baseline and 2Y leg pain, Charlson, frailty, and radiographic measures for the operative (OP) and non-operative cohorts (NOP). Health related quality of life (HRQL), surgical and radiographic metrics were compared. Regression models identified predictors of happy patients. Thresholds were calculated using area under the curve (AUC) and 95%CI. Results Of 480 patients, 94 OP (happy: 47 vs. control: 47) and 92 NOP (46 each) reached inclusion. At baseline, groups had similar age, gender, Oswestry disability index (ODI) (OP: 39.13 vs. 37.49, NOP: 17.70 vs. 19.74) and SF36-physical component score (PCS) (OP: 33.51 vs. 35.04, NOP: 47.93 vs. 44.72). Despite similar (P>0.05) surgeries, length of stay (LOS), and radiographic outcomes between OP happy and control groups, happy had less peri-operative complications (31.9% vs. 57.4%, P=0.13), better 2Y ODI (17.77 vs. 29.98), SRS22 component, total, and SF36 scores (P<0.05). NOP happy patients also exhibited better 2Y ODI (13.24 vs. 22.09), SRS22 component, total, and SF36 scores (P<0.05). Baseline SRS-mental (OR: 2.199, AUC: 0.617, cutoff: 2.5) and ODI improvement (OR: 1.055, AUC: 0.717, cutoff: >12) predicted happy OP patients, while baseline SRS-self-image (OR: 5.195, AUC: 0.740, cutoff: 3.5) and ODI improvement (OR: 1.087, AUC: 0.683, cutoff: >9) predicted happy NOP patients. Conclusions Baseline mental-status, self-image and ODI improvement significantly impact long-term happiness in ASD patients. Despite equivalent management and alignment outcomes, operative and non-operative happy patients had better 2Y disability scores. Management strategies aimed at improving baseline mental-status, perception-of-deformity, and maximizing ODI may optimize treatment outcomes.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Nicholas J Frangella
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Max I Egers
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
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Kalakoti P, Sciubba DM, Pugely AJ, McGirt MJ, Sharma K, Patra DP, Phan K, Madhavan K, Menger RP, Notarianni C, Guthikonda B, Nanda A, Sun H. Impact of Psychiatric Comorbidities on Short-Term Outcomes Following Intervention for Lumbar Degenerative Disc Disease. Spine (Phila Pa 1976) 2018; 43:1363-1371. [PMID: 29481379 DOI: 10.1097/brs.0000000000002616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, observational cohort study. OBJECTIVE To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for lumbar degenerative disc disease (LDDD). SUMMARY OF BACKGROUND DATA Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for LDDD. METHODS Adult patients (>18 yr) registered in the Nationwide Inpatient Sample database (2002-2011) and undergoing an elective spine fusion for LDDD that met inclusion criteria formed the study population. Defined primary outcome measures were discharge disposition, length of stay, hospitalization cost, and short-term postsurgical complications (neurological, respiratory, cardiac, gastrointestinal, wound complication and infections, venous thromboembolism, and acute renal failure). Multivariable regression techniques were used to explore the association of psychiatric comorbidities on short-term outcomes by adjusting for patient demographics, clinical, and hospital characteristics. RESULTS Of the 126,044 adult patients undergoing fusion surgery for LDDD (mean age: 54.91 yr, 58% female) approximately 18% had a psychiatric disease. Multivariable regression analysis revealed patients with psychiatric disease undergoing fusion surgery have higher likelihood for unfavorable discharge (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.35-1.47; P < 0.001), length of stay (OR 1.03; 95% CI 1.02-1.04; P < 0001), postsurgery neurologic complications (OR 1.25; 95% CI 1.13-1.37; P < 0.001), venous thromboembolic events (OR 1.38 95% CI 1.26-1.52; P < 0.001), and acute renal failure (OR 1.17; 95% CI 1.01-1.37; P = 0.040). Patients with psychiatric disease were also associated to have higher hospitalization cost (6.3% higher; 95% CI: 5.6%-7.1%; P < 0.001) compared to those without it. CONCLUSION Our study quantifies the estimates for presence of concomitant psychiatric comorbid conditions on short outcomes in patients undergoing fusions for LDDD. The data provide supporting evidence for adequate preoperative planning and postsurgical care including consultation for mental health for favorable outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew J Pugely
- Department of Spine Surgery, Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Devi P Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Karthik Madhavan
- Department of Neurosurgery, Miller School of Medicine, University of Miami, FL
| | - Richard P Menger
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
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O’Leary S, Cottrell M, Raymer M, Smith D, Khan A. General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings. BMC Musculoskelet Disord 2018; 19:348. [PMID: 30261861 PMCID: PMC6161322 DOI: 10.1186/s12891-018-2265-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To explore patient characteristics predictive of a poor response to multidisciplinary non-surgical rehabilitation of three common orthopaedic conditions within a tertiary care service. METHODS A retrospective audit of medical records of patients who had undergone multidisciplinary non-surgical management of their knee osteoarthritis (KOA, n = 190), shoulder impingement syndrome (SIS, n = 199), or low back pain (LBP, n = 242) within a multisite tertiary care service was undertaken. Standardised clinical measures recorded by the service at the initial consultation were examined using a base binary logistic regression model to determine their relationship with a poor response to management (ie. not achieving a minimal clinically important improvement in the condition disability measure pre-post management). RESULTS Factors predictive of a poor response following non-surgical management included;; higher levels of anxiety (OR 1.11, P < 0.02) and lower functional score (OR 0.76, P < 0.04) for KOA, higher number of comorbidities (OR 1.16, P < 0.03) for SIS, and coexisting cervical or thorax pain (OR 2.1, P = 0.04) and lower pain self-efficacy (OR 0.98, P = 0.02) for LBP. CONCLUSIONS General health issues may present a barrier to achieving favourable outcomes in response to multidisciplinary non-surgical rehabilitation for the management of common orthopaedic conditions in a tertiary care setting. Clinicians may need to consider these broader patient issues when designing management strategies for patients with these conditions.
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Affiliation(s)
- Shaun O’Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Michelle Cottrell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Physiotherapy Department, Ipswich Hospital, Ipswich, Australia
| | - Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - David Smith
- Physiotherapy Department, Ipswich Hospital, Ipswich, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Strøm J, Bjerrum MB, Nielsen CV, Thisted CN, Nielsen TL, Laursen M, Jørgensen LB. Anxiety and depression in spine surgery-a systematic integrative review. Spine J 2018; 18:1272-1285. [PMID: 29649613 DOI: 10.1016/j.spinee.2018.03.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. PURPOSE We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. STUDY DESIGN An integrative literature review was carried out. METHODS The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings. RESULTS Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health. CONCLUSIONS Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.
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Affiliation(s)
- Janni Strøm
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark.
| | - Merete B Bjerrum
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Claus V Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark
| | - Cecilie N Thisted
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Tove L Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark; Department of Occupational Therapy, VIA University College, Hedeager 2 Aarhus N, 8200, Denmark
| | - Malene Laursen
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark
| | - Lene B Jørgensen
- Department of Clinical Medicine, Aarhus University, PalleJuul-Jensens Boulevard 82, Aarhus N, 8200, Denmark; Regional Hospitals of Central Denmark Region, Heibergsalle 1-4, 8800, Viborg, 8800, Denmark
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Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis: a systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1604-1613. [PMID: 29508075 DOI: 10.1007/s00586-018-5520-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/31/2018] [Accepted: 02/10/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient's walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe patient's walking ability. Objective methods to assess walking capacity and performance is being investigated and used alongside the traditional use of PROs. This review of the literature was made to provide an overview of relations between the ODI and outcome measures of walking capacity and performance in spinal stenosis research, and to provide a strategy for improving such measures in future research. METHODS The review was conducted according to the Prisma Statement. In February 2017, a search was performed in Pubmed, Embase and Cochrane database. Authors independently screened articles by title, abstract, and full text, and studies were included if both authors agreed. Articles with correlation analysis between the ODI, walking capacity and performance measures by accelerometer or GPS were included. RESULTS The results support a correlation between the ODI and walking capacity measures. The available studies using ODI and accelerometers were too few to reach a conclusion regarding correlation between ODI and walking performance. No articles with GPS measure were identified. CONCLUSIONS The ODI should not stand alone when evaluating walking limitations in patients with lumbar spinal stenosis. To enable a comprehensive assessment of walking ability, a walking test should be used to assess walking capacity and accelerometers should be investigated and standardized in measuring walking performance. These slides can be retrieved under Electronic Supplementary Material.
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Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit. Spine (Phila Pa 1976) 2018; 43:141-147. [PMID: 20736893 DOI: 10.1097/brs.0b013e3181cdb5fc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, correlational, exploratory, clinical research. OBJECTIVE To identify the factors determining a patient's recovery after conservative treatment of compression fractures of the thoracolumbar spine. SUMMARY OF BACKGROUND DATA The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site, or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown. METHODS In 48 conservatively treated patients the preinjury versus the 12-month follow-up differences (Δ) in back pain (visual analogue scale for pain), Oswestry disability index (ODI), and the Greenough and Fraser low back outcome scale were prospectively recorded. For these differences and for time lost from work and satisfaction, multiple linear regressions with combinations of 16 factors were performed. RESULTS At 1 year, patients with an income-insurance were 9% (P = 0.096) more disabled than those without. They reported a 15% less favorable global outcome and 27% less participation. Smokers were 13% (P = 0.010) more disabled and 11% (P = 0.044) less satisfied. With each increase of the AO-fracture type from A1 to A3 the disability was 8% worse. Patients with pre-existent chronic low back pain (CLBP) returned two points (on a visual analogue scale [VAS] pain total of 10) more closely (P = 0.041) to their preinjury pain level than those without but were 21% (P = 0.001) less satisfied. Our model offers an explanation for more than 25% of the variability of ΔODI and of the satisfaction. For sick leave, no significant predictors were found. CONCLUSION Smoking and insurance status are the strongest negative predictors for recovery. LBP patients returned more closely to their preinjury back pain level, but were less satisfied. The AO fracture type had a marked influence on disability, the sagittal deformity had not. The time lost from work did not depend on patient or injury-related factors. LEVEL OF EVIDENCE N/A.
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Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, Shaffrey CI, Shaffrey ME, Coric D, Knightly JJ, Park P, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Chotai S, DiGiorgio AM, Chan AY, Haid RW, Mummaneni PV. Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurg Focus 2018; 44:E3. [DOI: 10.3171/2017.10.focus17553] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing results from recent randomized controlled trials have established a need to clarify the groups that would most benefit from surgery for degenerative lumbar spondylolisthesis. In the present study, the authors compared patients who were the most and the least satisfied following surgery for degenerative lumbar spondylolisthesis.METHODSThis was a retrospective analysis of a prospective, national longitudinal registry including patients who had undergone surgery for grade 1 degenerative lumbar spondylolisthesis. The most and least satisfied patients were identified based on an answer of “1” and “4,” respectively, on the North American Spine Society (NASS) Satisfaction Questionnaire 12 months postoperatively. Baseline demographics, clinical variables, surgical parameters, and outcomes were collected. Patient-reported outcome measures, including the Numeric Rating Scale (NRS) for back pain, NRS for leg pain, Oswestry Disability Index (ODI), and EQ-5D (the EuroQol health survey), were administered at baseline and 3 and 12 months after treatment.RESULTSFour hundred seventy-seven patients underwent surgery for grade 1 degenerative lumbar spondylolisthesis in the period from July 2014 through December 2015. Two hundred fifty-five patients (53.5%) were the most satisfied and 26 (5.5%) were the least satisfied. Compared with the most satisfied patients, the least satisfied ones more often had coronary artery disease (CAD; 26.9% vs 12.2%, p = 0.04) and had higher body mass indices (32.9 ± 6.5 vs 30.0 ± 6.0 kg/m2, p = 0.02). In the multivariate analysis, female sex (OR 2.9, p = 0.02) was associated with the most satisfaction. Notably, the American Society of Anesthesiologists (ASA) class, smoking, psychiatric comorbidity, and employment status were not significantly associated with satisfaction. Although there were no significant differences at baseline, the most satisfied patients had significantly lower NRS back and leg pain and ODI scores and a greater EQ-5D score at 3 and 12 months postoperatively (p < 0.001 for all).CONCLUSIONSThis study revealed that some patient factors differ between those who report the most and those who report the least satisfaction after surgery for degenerative lumbar spondylolisthesis. Patients reporting the least satisfaction tended to have CAD or were obese. Female sex was associated with the most satisfaction when adjusting for potential covariates. These findings highlight several key factors that could aid in setting expectations for outcomes following surgery for degenerative lumbar spondylolisthesis.
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Affiliation(s)
- Andrew K. Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F. Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T. Foley
- 5Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Eric A. Potts
- 6Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Christopher I. Shaffrey
- 7Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mark E. Shaffrey
- 7Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Domagoj Coric
- 8Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery & Spine Associates, Charlotte, North Carolina
| | | | - Paul Park
- 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L. Asher
- 8Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery & Spine Associates, Charlotte, North Carolina
| | - Michael S. Virk
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Silky Chotai
- 13Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Anthony M. DiGiorgio
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 14Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and
| | - Alvin Y. Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Praveen V. Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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Chotai S, Devin CJ, Archer KR, Bydon M, McGirt MJ, Nian H, Harrell FE, Dittus RS, Asher AL, McGirt MJ, Devin CJ, Foley KT, Sorenson JM, Knightly JJ, Glassman SD, Briggs TB, Kremer A, Griffitt WE, Stadlan NY, Grahm TW, Schmidt MH, Mummaneni P, Shaffrey ME. Effect of patients' functional status on satisfaction with outcomes 12 months after elective spine surgery for lumbar degenerative disease. Spine J 2017; 17:1783-1793. [PMID: 28970074 DOI: 10.1016/j.spinee.2017.05.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 05/02/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported Oswestry Disability Index (ODI) scores at baseline and 12 months on satisfaction with outcomes following spine surgery is not well documented. PURPOSE This study aimed to determine the impact of patient disability (ODI) scores at baseline and 12 months on satisfaction with outcomes following surgery. STUDY DESIGN Analysis of prospectively collected longitudinal web-based multicenter data. PATIENT SAMPLE Patients undergoing elective surgery for degenerative lumbar disease were entered into a prospective multicenter registry. OUTCOME MEASURES Primary outcome measures were ODI, North American Spine Society satisfaction (NASS) questionnaire. METHODS Baseline and 12-month ODI scores were recorded. Satisfaction at 12 months after surgery was measured using NASS questionnaire. Multivariable proportional odds logistic regression analysis was conducted to determine the impact of baseline and 12-month ODI on satisfaction with outcomes. RESULTS Of the total 5,443 patients, 64% (n=3,460) were satisfied at a level where surgery met their expectations (NASS level 1) at 12 months after surgery. After adjusting for all baseline and surgery-specific variables, the 12-month ODI score had the highest impact (Wald χ2=1,555, 86% of the total χ2) on achieving satisfaction with outcomes compared with baseline ODI scores (Wald χ2=93, 5% of the total χ2). The level of satisfaction decreases with increasing 12-month ODI score. Greater change in ODI is required to achieve a better satisfaction level when the patient starts with a higher baseline ODI score. CONCLUSION Absolute 12-month ODI following surgery had a significant association on satisfaction with outcomes 12 months after surgery. Patients with higher baseline ODI required a larger change in ODI score to achieve satisfaction. No single measure can be used as a sole yardstick to measure quality of care after spine surgery. Satisfaction may be used in conjunction with baseline and 12-month ODI scores to provide an assessment of the quality of spine surgery provided in a patient centric fashion.
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Affiliation(s)
- Silky Chotai
- Department of Orthopaedic and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clinton J Devin
- Department of Orthopaedic and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin R Archer
- Department Orthopaedic Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Robert S Dittus
- Departments of Medicine, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA; VA Tennessee Valley Geriatric Research, Education and Clinical Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Anthony L Asher
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, NC, USA.
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Bouras T, Zairi F, Loufardaki M, Triffaux M, Stranjalis G. Which functional outcome parameters correlate better with elderly patients' satisfaction after non-fusion lumbar spine surgery? J Neurosurg Sci 2017; 63:365-371. [PMID: 28699719 DOI: 10.23736/s0390-5616.17.03977-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Elderly patients are increasingly operated for spinal degenerative diseases. The treatment objective is quality of life, which, in this population, is difficult to assess. Hence, patient satisfaction, although less objective, is of high importance. In this study, we have examined the relation of various functional parameters after non-fusion spinal surgery, with patient satisfaction. METHODS A 5-year follow-up after non-fusion lumbar spine surgery on 185 elderly patients was performed. Demographics, co-morbidity factors, type of lesion and operation performed were recorded. The Oswestry Disability Index (ODI) was calculated. Also, walking distance, use of analgesics, daily activities, social life and patient mobility were assessed by means of study-specific stratified pain-independent questionnaires. Finally, patient satisfaction was assessed by the single-item satisfaction question. RESULTS Postoperative ODI, and the improvement regarding ODI, analgesic use and walking distance indices were independent factors influencing patient satisfaction. The insertion of pain analog scale score into this model altered the results, and along with this score, only the walking distance improvement remained an independent statistically significant factor. When the independent from pain scales were used, the improvement of the walking distance score were independently related to the satisfaction of the elderly. CONCLUSIONS ODI is applicable in elderly patients, even with the exception of some of the categories assessed. Walking capacity should be assessed separately from other pain-dependent activities; its improvement should be an independent goal of lumbar spine surgery in the elderly. The level of the elderly patient subjectivity in auto-assessing the outcome of lumbar spine surgery is high, and objective outcome measurements remain important.
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Affiliation(s)
- Triantafyllos Bouras
- Department of Neurosurgery, Hospital of Wallonia and Picardy (CHWAPI), Tournai, Belgium -
| | - Fahed Zairi
- Department of Neurosurgery, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Maria Loufardaki
- Prof. Petros Kokkalis Hellenic Center of Neurosurgical Research, Athens, Greece
| | - Michel Triffaux
- Department of Neurosurgery, Hospital of Wallonia and Picardy (CHWAPI), Tournai, Belgium
| | - George Stranjalis
- Prof. Petros Kokkalis Hellenic Center of Neurosurgical Research, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece
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Preoperative Depression, Smoking, and Employment Status are Significant Factors in Patient Satisfaction After Lumbar Spine Surgery. Clin Spine Surg 2017. [PMID: 28632560 DOI: 10.1097/bsd.0000000000000331] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To determine whether comorbidities and demographics, identified preoperatively, can impact patient outcomes and satisfaction after lumbar spine surgery. SUMMARY OF BACKGROUND DATA The surgical treatment of lower back pain does not always eliminate a patient's pain and symptoms. Revision surgeries are costly and expose the patient to additional risk. We aim to identify patient characteristics that may suggest a greater or lesser likelihood of postsurgical success by examining patient-reported measures and outcomes after surgery. METHODS Preoperative smoking status, self-reported depression, prevalence of diabetes, obesity, level of education, and employment status were assessed in the context of patient outcome and satisfaction after lumbar spine surgery. Patients were contacted before surgery, and at 3 and 12 months postoperatively, and responded to Oswestry Disability Index (ODI) and EuroQol-5 Dimensions (EQ-5D) self-assessment examinations, as well as a satisfaction measure. RESULTS A total of 166 patients who underwent lumbar spine surgeries at Iowa Spine and Brain Institute, a department of Covenant Medical Center, and were included in the National Neurosurgery Quality and Outcomes Database were assessed preoperatively, and at 3 and 12 months postoperatively using self-assessment tools. Depression, smoking, and employment status were found to be significant factors in patient satisfaction. Depressed patients, smokers, and patients on disability at the time of surgery have worse ODI and EQ-5D scores at all of the timepoints (baseline, 3 months, and 12 months postsurgery). CONCLUSIONS Depression, smoking, and employment status, specifically whether a patient is on disability at the time of surgery, are all significant factors in patient satisfaction after lumbar spine surgery. These factors are also shown in impact ODI and EQ-5D scores. Surgeons should consider these particular characteristics when developing a lower back pain treatment plan involving surgery.
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Scoping review to develop common data elements for lumbar spinal stenosis. Spine J 2017; 17:1045-1057. [PMID: 28434926 DOI: 10.1016/j.spinee.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/20/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Common data elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. Although CDEs have been developed for a number of disorders, to date CDEs for lumbar spinal stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages the International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS. PURPOSE The study aimed to define CDEs for disease characteristics and outcomes of LSS using the World Health Organization's ICF taxonomy, and to facilitate the selection of assessment instruments for research and clinical care. DESIGN This is a scoping review using a modified Delphi approach with a technical expert panel composed of clinicians and scientists representing the academia, policy and advocacy stakeholders, and professional associations with expertise in LSS. METHODS This is a scoping review to identify measures that assess LSS symptoms. Thirty-one subject matter experts (SMEs) prioritized ICF codes and evaluated instruments measuring specific domains. We used a modified Delphi technique to evaluate item-level content and achieve consensus. RESULTS SMEs prioritized 53 ICF codes; 3 received 100% endorsement, 27 received ≥90% endorsement, whereas the remaining 23 received ≥80% endorsement. Prioritized ICF codes represent diverse domains, including pain, activities and participation, and emotional well-being. The review yielded 58 instruments; we retained 24 for content analysis. CONCLUSIONS The retained instruments adequately represent the ICFs activities and participation, and body function domains. Body structure and environmental factors were assessed infrequently. Adoption of these CDEs may guide clinical decision making and facilitate comparative effectiveness trials for interventions focused on LSS.
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Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of a Combined Prospective Dataset. Spine (Phila Pa 1976) 2017; 42:372-378. [PMID: 27398891 DOI: 10.1097/brs.0000000000001777] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of a combined prospective dataset. OBJECTIVE To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Psychiatric comorbidities, including depression, have been associated with worse clinical outcomes after lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. METHODS Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6, 12, and 24 months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36v2) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months among patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. RESULTS Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (P < 0.0001). Patients with psychiatric comorbidities were more likely to have cardiovascular (P = 0.0177), respiratory (P < 0.0001), gastrointestinal (P < 0.0001), rheumatologic (P = 0.0109), and neurologic (P = 0.0309) disorders. At 24 months after surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI, and SF-36v2 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36v2 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24 months among patients in each group. Improvement in NDI, SF-36v2 PCS, and MCS, however, were smaller in patients with depression or bipolar disorder than those without. CONCLUSION Patients with depression or bipolar disorder have smaller functional and quality of life improvements after surgery compared to patients without psychiatric comorbidities. LEVEL OF EVIDENCE 2.
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Hartzell MM, Liegey-Dougall A, Kishino ND, Gatchel RJ. Utility of Pain Drawings Rated for Non-Organic Pain in Chronic Low Back Pain Populations: A Qualitative Systematic Review. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/jabr.12048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Meredith M. Hartzell
- Department of Psychology; College of Science; The University of Texas at Arlington
| | | | | | - Robert J. Gatchel
- Department of Psychology; College of Science; The University of Texas at Arlington
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Chotai S, Sivaganesan A, Parker SL, McGirt MJ, Devin CJ. Patient-Specific Factors Associated With Dissatisfaction After Elective Surgery for Degenerative Spine Diseases. Neurosurgery 2015; 77:157-63; discussion 163. [DOI: 10.1227/neu.0000000000000768] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
STUDY DESIGN Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement database. OBJECTIVE We assessed whether preoperative cigarette smoking and smoking duration predicted adverse, early, perioperative outcomes in patients undergoing elective spine surgery. SUMMARY OF BACKGROUND DATA Prior studies have assessed the association of smoking and long-term outcomes for a number of spine surgery procedures, with conflicting findings. The association between smoking and 30-day outcomes for spine surgery is unknown. METHODS A total 14,500 adults, classified as current (N = 3914), prior (N = 2057), and never smokers. Using propensity scores, current and prior smokers were matched to never smokers. Logistic regression was used to predict adverse postoperative outcomes. The relationship between pack-years and adverse outcomes was tested. Sensitivity analyses were conducted limiting the study sample to patients who underwent spine fusion (N = 4663), and using patient subgroups by procedure. RESULTS In unadjusted analyses, prior smokers were significantly more likely to have prolonged hospitalization (1.2, 95% confidence interval [CI]: 1.1-1.3) and major complications (1.3, 95% CI: 1.1-1.6) compared with never smokers. No association was found between smoking status and adverse outcomes in adjusted, matched patient models. Current smokers with more than 60 pack-years were more likely to die within 30 days of surgery (3.0, 95% CI, 1.1-7.8), compared with never smokers. Sensitivity analyses confirmed these findings. CONCLUSION The large National Surgical Quality Improvement population was carefully matched for a wide range of baseline comorbidities, including 29 variables previously suggested to influence perioperative outcomes. Although previous studies conducted in subgroups of spine surgery patients have suggested a deleterious effect for smoking on long-term outcomes in patients undergoing spine surgery, our analysis did not find smoking to be associated with early (30 d) perioperative morbidity or mortality.
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Aalto T, Sinikallio S, Kröger H, Viinamäki H, Herno A, Leinonen V, Turunen V, Savolainen S, Airaksinen O. Preoperative Predictors for Good Postoperative Satisfaction and Functional Outcome in Lumbar Spinal Stenosis Surgery — A Prospective Observational Study with a Two-Year Follow-up. Scand J Surg 2012; 101:255-60. [DOI: 10.1177/145749691210100406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Lumbar spinal stenosis (LSS) is the most frequent indication for back surgery in adults aged over 65 years, but about one-third of operated patients have less than good/excellent results from the operation. Awareness of outcome predictors and their predictive values may help clinicians in their assessment of the prognosis of patients when considering surgical treatment. Our aim was to study the preoperative predictors in LSS for a good postoperative outcome (satisfaction with surgery and functional improvement) with a two-year follow-up. Material and Methods: LSS patients (n = 102) completed a questionnaire preoperatively and on two-year follow-up. Preoperative patient-related predictors, self-rated health, comorbidities and preoperative treatment were assessed. Satisfaction with the surgical outcome was assessed with a seven-category scale; satisfaction was determined to be good if the patient response was “condition has considerably improved” or “totally cured”. Other responses (“condition has slightly improved” or worse) represented poorer satisfaction. A good functional outcome was determined as > 30% relative improvement compared to the presurgery score in the Oswestry Disability Index (ODI). Results: The predictors for good satisfaction were age < 75 years at operation (OR 4.03; 95% CI 1.35–12.02; p = 0.012) and no previous lumbar operation (OR 3.65; 95% CI 1.13–11.79; p = 0.031). Predictors for a good improvement in the ODI score were regular preoperative analgesic use < 12 months (OR 3.40; 95% CI 1.21–9.53; p = 0.020), non-smoking (OR 3.47; 95% CI 1.09–11.03; p = 0.035) and good (above average) self-rated health (OR 3.27; 95% CI 1.06–10.12; p = 0.039). Conclusions: In LSS, regular analgesic treatment preoperatively for 12 months or less, self-rated health above average and non-smoking predicted a good postoperative functional improvement. An age under 75 years and no previous lumbar operation predicted good postoperative satisfaction with the surgery.
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Affiliation(s)
- T. Aalto
- Kyyhkylä Rehabilitation Center and Hospital, Mikkeli, Finland
| | - S. Sinikallio
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - H. Kröger
- Department of Orthopaedics and Traumatology, Kuopio University Hospital and Bone Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland
| | - H. Viinamäki
- Institute of Clinical Medicine, Psychiatry. University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - A. Herno
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - V. Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - V. Turunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - S. Savolainen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - O. Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
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Maratos EC, Trivedi R, Richards H, Seeley H, Laing RJC. Psychological distress does not compromise outcome in spinal surgery. Br J Neurosurg 2012; 26:466-71. [DOI: 10.3109/02688697.2011.644821] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yoshino CV, Rodrigues LMR. Avaliação da qualidade de vida em pacientes submetidos à cirurgia de estenose de canal lombar com mais de 60 anos. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar as mudanças na qualidade de vida antes e após a cirurgia de artrodese lombar através dos questionários Owestry Disablity Index (ODI), Roland-Morris (RM) e Escala Analógica Visual (VAS). MÉTODOS: Foram avaliadas as mudanças nos questionários (ODI, RM e VAS) entre o pré-operatório, 1 semana, 1 mês, 2 meses, 6 meses, 1 ano e 2 anos após o procedimento cirúrgico. RESULTADOS: Foram estudados 38 pacientes com idade acima de 60 anos com acompanhamento de pelo menos dois anos. Houve uma melhora no ODI de 55,94%, 49,18 no RM e 39,48 no VAS. CONCLUSÃO: Os resultados mostram uma melhora nos índices analisados, apresentando índices semelhantes a estudos anteriores, apesar da discrepância entre os diversos estudos e à falta de dados referentes à nossa população.
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Thornes E, Ikonomou N, Grotle M. Prognosis of surgical treatment for degenerative lumbar spinal stenosis: a prospective cohort study of clinical outcomes and health-related quality of life across gender and age groups. Open Orthop J 2011; 5:372-8. [PMID: 22135713 PMCID: PMC3228230 DOI: 10.2174/1874325001105010372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/12/2011] [Accepted: 09/16/2011] [Indexed: 11/22/2022] Open
Abstract
Degenerative lumbar spinal stenosis is a common condition and the most usual indication for spinal surgery in adult patients. The main objective of this study was to investigate clinical outcomes, health-related quality of life (HRQoL) and satisfaction among patients with a diagnosed lumbar spinal stenosis who were surgically treated, and whether these outcomes differed according to gender and age. Surgery was performed on 100 patients with clinical and radiological defined lumbar spinal stenosis. All patients completed questionnaires twice before surgery and at 6 weeks, 12 weeks, and 1 year postoperatively. Main outcomes were symptoms, physical function and patient satisfaction assessed by the Swiss Spinal Stenosis Questionnaire and HRQoL by the Short Form 36 health survey (SF36). There were large improvements in all clinical outcomes and in the physical subscales of the SF36. A marked reduction of average 32.3% was seen in symptoms already at 6 weeks follow-up. Physical function had improved with an average of 29.8% at 1-year follow-up. There was no statistical significant effect of age and gender on symptoms and physical function. Patients more than 65 years were significantly less satisfied at the 1-year follow-up as compared to the younger patients (p=0.012). This study showed that the majority of patients improved significantly in symptoms, physical function and physical HRQoL after surgery for degenerative lumbar spinal stenosis, regardless of age and gender. Age showed to be closely connected to satisfaction.
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Affiliation(s)
| | | | - Margreth Grotle
- FORMI (Communication Unit for Musculoskeletal Disorders), Oslo University Hospital, Norway
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norway
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Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: a study of 4555 patients from the Swedish spine register. Spine (Phila Pa 1976) 2011; 36:1059-64. [PMID: 21224770 DOI: 10.1097/brs.0b013e3181e92b36] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cohort study based on the Swedish Spine Register. OBJECTIVE To determine the relation between smoking status and disability after surgical treatment for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA Smoking and nicotine have been shown to inhibit lumbar spinal fusion and promote disc degeneration. No association, however, has previously been found between smoking and outcome after surgery for lumbar spinal stenosis. A large prospective study is therefore needed. METHODS All patients with a completed 2-year follow-up in the Swedish Spine Register operated for central lumbar stenosis before October 1, 2006 were included. Logistic regression was used to assess the association between smoking status and outcomes. RESULTS Of 4555 patients enrolled, 758 (17%) were current smokers at the time of surgery. Smokers had an inferior health-related Quality of Life at baseline. Nevertheless, adjusted for differences in baseline characteristics, the odds ratio (OR) for a smoker to end up dissatisfied at the 2-year follow-up after surgery was 1.79 [95% confidence interval (CI) 1.51-2.12]. Smokers had more regular use of analgesics (OR 1.86; 95% CI 1.55-2.23). Walking ability was less likely to be significantly improved in smokers with an OR of 0.65 (95% CI 0.51-0.82). Smokers had inferior Quality of Life also after taking differences before surgery into account, either when measured with the Oswestry Disability Index (ODI; P < 0.001), EuroQol (P < 0.001) or Short Form (36) Health Survey (SF-36) BP and SF-36 PF (P < 0.001). The differences in results between smokers and nonsmokers were evident, irrespective of whether the decompression was done with or without spinal fusion. CONCLUSION Smoking is an important predictor for 2-year results after surgery for lumbar spinal stenosis. Smokers had less improvement after surgery than nonsmokers.
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Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1331-40. [PMID: 21523459 DOI: 10.1007/s00586-011-1781-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/23/2011] [Accepted: 03/25/2011] [Indexed: 12/19/2022]
Abstract
The aim was to study if postoperative rehabilitation improves functional outcome in lumbar spinal stenosis (LSS). Surgically treated LSS patients (n = 102) were randomized to rehabilitation-group (A) and "standard postoperative treatment"--group (B). Intervention for A-group started 3 months postoperatively, consisting of once a week outpatient visits for 12 weeks (1.5 h per visit; 1-6 patients per one physiotherapist). Physiotherapist guided stretching and strengthening exercises. A-group performed individually estimated exercises at those visits with guiding and at home up to 24-month postoperative follow-up. Physiotherapeutic guidance (12 times) was repeated after 12 months, in order to update exercises and motivate patients to keep training. For B-group, the "standard treatment" thus included normal postoperative treatment, or no treatment/self-management. Outcome measures were measured at the start and the end of the first physiotherapeutic intervention (3 and 6 months postoperatively), and at 12- and 24-month postoperative follow-ups. Oswestry Disability Index (ODI, 0-100%) was the main outcome measure. The other outcome measures were back- and leg pain separately (NRS-11); satisfaction (7-point scale) and treadmill test (0-1,000 m; not at 6 month). The intervention consisting of 12 + 12 physiotherapeutic sessions with further home exercises did not influence the course ODI in the 24-month postoperative follow-up (p = 0.95 for ODI; "as-rehabilitated" analysis). No influence on any other outcome measures was observed. After LSS surgery, routinely performed outpatient rehabilitation did not improve functional outcome compared to standard treatment. In addition, it had no impact on the back and leg pain, satisfaction and walking ability.
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Bouras T, Stranjalis G, Loufardaki M, Sourtzis I, Stavrinou LC, Sakas DE. Predictors of long-term outcome in an elderly group after laminectomy for lumbar stenosis. J Neurosurg Spine 2010; 13:329-34. [DOI: 10.3171/2010.3.spine09487] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
This is a retrospective long-term outcome study of results after laminectomy for lumbar spinal stenosis in an elderly group of patients. The study was designed to evaluate possible demographic, comorbidity, and clinical prognosticators for pain reduction and functional improvement in this population. Because the assessment of functional outcome in the elderly is complicated by several specific factors, the use of outcome measurement parameters should be revised and refined. Moreover, despite numerous relevant studies, the results of various techniques remain equivocal, particularly among the elderly, which renders the implementation of focused studies necessary. New data could be used to refine patient selection and choice of technique to improve prognosis.
Methods
During a 5-year period, lumbar laminectomies were performed in 182 elderly patients. Of these 182, 125 patients (68.8%) were followed up for a mean period of 60.8 months. The outcome was assessed by means of pain visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), and patient satisfaction questionnaire, and results were correlated to demographic (age, sex), comorbidity (Charlson Comorbidity Index, diabetes, depression, and history of lumbar spine surgery), and clinical (main preoperative complaint, preoperative VAS score, and ODI) factors.
Results
In terms of the VAS score, 106 patients (84.8%) exhibited improvement at follow-up. The corresponding ODI improvement rate was 69.6% (87 patients). The mean VAS and ODI differences were 5.1 and 29.1, respectively. One hundred two patients (81.6%) were satisfied with the results of the operation. Univariate analysis for possible prognostic factors revealed the significant influence of low-back pain on VAS score (p = 0.024) and ODI (p < 0.001) not improving, while the ODI was also affected by sex (females had a poorer outcome [p = 0.019]). In contrast, patient satisfaction was not related to any of the preoperative parameters recorded; nevertheless, it was strongly related to all functional measurements on follow-up.
Conclusions
Considering the methodological issues of such studies, particularly in elderly patients, the authors conclude that the ODI is more sensitive than the VAS score in assessing prognostic value and that patient satisfaction is difficult to prognosticate, underscoring the particularities that this population presents regarding functionality assessment. Considering the prognostic value of preoperative factors, a negative influence of low-back pain and female sex is reported.
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Affiliation(s)
- Triantafyllos Bouras
- 1Department of Neurosurgery, Evangelismos Hospital; and
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
| | - George Stranjalis
- 1Department of Neurosurgery, Evangelismos Hospital; and
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
| | - Maria Loufardaki
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
| | - Ilias Sourtzis
- 1Department of Neurosurgery, Evangelismos Hospital; and
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
| | - Lampis C. Stavrinou
- 1Department of Neurosurgery, Evangelismos Hospital; and
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
| | - Damianos E. Sakas
- 1Department of Neurosurgery, Evangelismos Hospital; and
- 2“Professor Petros S. Kokkalis”Hellenic Center for Neurosurgical Research, University of Athens, Greece
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Kong CB, Jeon DW, Chang BS, Lee JH, Suk KS, Park JB. Outcome of spinal fusion for lumbar degenerative disease: a cross-sectional study in Korea. Spine (Phila Pa 1976) 2010; 35:1489-94. [PMID: 20535050 DOI: 10.1097/brs.0b013e3181c49fd0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE To evaluate the degree of postoperative pain and patients' satisfaction after lumbar fusion from a nationwide survey in Korea. SUMMARY OF BACKGROUND DATA There have been few studies that investigated the factors related to patients' satisfaction after spinal fusion in lumbar degenerative disease (LDD). METHODS This study included 629 patients who underwent spinal fusion for LDD at clinics of designated members of the Korean Society of Spine Surgery. This survey was done in 123 hospitals with 171 spine surgeons. Questionnaires for patients included severity of present back pain and radicular pain (visual analog scale score), Oswestry Disability Index (ODI), and subjective outcomes. Questionnaire for surgeons included preoperative diagnosis, level of fusion, operative method, and presumed patient's pain. RESULTS The patients were 199 men and 430 women, with mean age of 62.3 years. The mean visual analog scale score of back pain and radicular pain was 5.0 +/- 2.6 and 4.4 +/- 3.0, respectively. The mean ODI was 44.3 +/- 19.4. ODI was significantly increased with older age, workers' compensation, and increased fusion extent. Correlated factors of dissatisfaction were severe back pain, higher ODI, multiple operation, and insufficient explanation about postoperative pain. There was a significant correlation between preoperative explanation about postoperative pain and degree of patient's pain. CONCLUSION Patients' satisfaction was not as high as expected after fusion for LDD. Therefore, the decision for performing a lumbar fusion in those patients must be done more carefully, and it should be explained more precisely that chronic pain may persist after spinal surgery.
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Affiliation(s)
- Chang-Bae Kong
- Department of Orthopaedic Surgery, Seoul National University, Seoul, Republic of Korea
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Jibodh SR, Kandil AO, Malchau H, Estok DM. Do commonly reported outcome measures reflect patient satisfaction after revision hip arthroplasty? J Arthroplasty 2010; 25:41-5. [PMID: 19056218 DOI: 10.1016/j.arth.2008.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 10/23/2008] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine which commonly reported outcome measures best correlated with patient satisfaction after revision hip arthroplasty and to identify factors unrelated to hip status that may also play a role. From our institutional database, we identified 78 patients (80 hips) who underwent revision total hip arthroplasty and collected follow-up data. Patients with moderate or severe pain and those with limited walking ability reported significantly lower satisfaction scores. Harris hip score and patient-rated general health status were independently associated with patient satisfaction. Patient-rated anxiety and depression correlated inversely with satisfaction. Commonly reported outcome measures do reflect patient satisfaction after revision hip arthroplasty. However, satisfaction also appears to be influenced by psychologic factors.
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Affiliation(s)
- Stefan R Jibodh
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Morse JS, Schallhorn SC, Hettinger K, Tanzer D. Role of depressive symptoms in patient satisfaction with visual quality after laser in situ keratomileusis. J Cataract Refract Surg 2009; 35:341-6. [PMID: 19185253 DOI: 10.1016/j.jcrs.2008.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
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