1
|
Agung Y, Hladkowicz E, Boland L, Moloo H, Lavallée LT, Lalu MM, McIsaac DI. Frailty and decisional regret after elective noncardiac surgery: a multicentre prospective cohort study. Br J Anaesth 2024:S0007-0912(24)00464-1. [PMID: 39232909 DOI: 10.1016/j.bja.2024.08.001] [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: 05/30/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Frailty is associated with morbidity and mortality after surgery. The association of frailty with decisional regret is poorly defined. Our objective was to estimate the association of preoperative frailty with decisional regret status in the year after surgery. METHODS We conducted a secondary analysis of a prospective, multicentre cohort study of patients aged ≥65 years who underwent elective noncardiac surgery. Decisional regret about having undergone surgery was ascertained at 30, 90, and 365 (primary time point) days after surgery using a 3-point ordinal scale. Bayesian ordinal logistic regression was used to estimate the association of frailty with decisional regret, adjusted for surgery type, age, sex, and mental health conditions. Subgroup and sensitivity analyses were conducted. RESULTS We identified 669 patients; 293 (43.8%) lived with frailty. At 365 days after surgery, the unadjusted odds ratio (OR) associating frailty with greater decisional regret was 2.21 (95% credible interval [CrI] 0.98-5.09; P(OR>1)=0.97), which was attenuated after confounder adjustment (adjusted OR 1.68, 95% CrI 0.84-3.36; P(OR>1)=0.93). Similar results were estimated at 30 and 90 days. Additional adjustment for baseline comorbidities and disability score substantially altered the OR at 365 days (0.89, 95% CrI 0.37-2.12; P(OR>1)=0.39). There was a high probability that surgery type was an effect modifier (non-orthopaedic: OR 1.90, 95% CrI 1.00-3.59; P(OR>1)=0.98); orthopaedic: OR 0.87, 95% CrI 0.41-1.91; P(OR>1)=0.36). CONCLUSIONS Among older surgical patients, there appears to be a complex association with frailty and decisional regret, with substantial heterogeneity based on assumed causal pathways and surgery type. Future studies are required to untangle the complex interplay between these factors.
Collapse
Affiliation(s)
- Yonathan Agung
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Boland
- Centre for Surveillance and Applied Research (CSAR), Public Health Agency of Canada, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Manoj M Lalu
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
2
|
Du JY, Lovecchio FC, Kazarian G, Clohisy J, Pajak A, Kaidi A, Knopp R, Akosman I, Johnson M, Nakarai H, Dash A, Samuel JT, Cunningham ME, Kim HJ. Decisional regret following corrective adult spinal deformity surgery: a single institution study of incidence and risk factors. Spine Deform 2024; 12:775-783. [PMID: 38289505 DOI: 10.1007/s43390-023-00790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/04/2023] [Indexed: 05/04/2024]
Abstract
PURPOSE To assess the characteristics and risk factors for decisional regret following corrective adult spinal deformity (ASD) surgery at our hospital. METHODS This is a retrospective cohort study of a single-surgeon ASD database. Adult patients (> 40 years) who underwent ASD surgery from May 2016 to December 2020 with minimum 2-year follow-up were included (posterior-only, ≥ 4 levels fused to the pelvis) (n = 120). Ottawa decision regret questionnaires, a validated and reliable 5-item Likert scale, were sent to patients postoperatively. Regret scores were defined as (1) low regret: 0-39 (2) medium to high regret: 40-100. Risk factors for medium or high decisional regret were identified using multivariate models. RESULTS Ninety patients were successfully contacted and 77 patients consented to participate. Nonparticipants were older, had a higher incidence of anxiety, and higher ASA class. There were 7 patients that reported medium or high decisional regret (9%). Ninety percentage of patients believed that surgery was the right decision, 86% believed that surgery was a wise choice, and 87% would do it again. 8% of patients regretted the surgery and 14% believed that surgery did them harm. 88% of patients felt better after surgery. On multivariate analysis, revision fusion surgery was independently associated with an increased risk of medium or high decisional regret (adjusted odds ratio: 6.000, 95% confidence interval: 1.074-33.534, p = 0.041). CONCLUSIONS At our institution, we found a 9% incidence of decisional regret. Revision fusion was associated with increased decisional regret. Estimates for decisional regret should be based on single-institution experiences given differences in patient populations.
Collapse
Affiliation(s)
- Jerry Y Du
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA.
| | | | - Gregory Kazarian
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - John Clohisy
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Anthony Pajak
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Austin Kaidi
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Rachel Knopp
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Izzet Akosman
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Mitchell Johnson
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Hiroyuki Nakarai
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Alexander Dash
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | - Justin T Samuel
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA
| |
Collapse
|
3
|
Maayan O, Shahi P, Merrill RK, Pajak A, Lu AZ, Oquendo Y, Subramanian T, Araghi K, Tuma OC, Korsun MK, Asada T, Singh N, Singh S, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Ninety Percent of Patients Are Satisfied With Their Decision to Undergo Spine Surgery for Degenerative Conditions. Spine (Phila Pa 1976) 2024; 49:561-568. [PMID: 38533908 DOI: 10.1097/brs.0000000000004714] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Cross-sectional survey and retrospective review of prospectively collected data. OBJECTIVE To explore how patients perceive their decision to pursue spine surgery for degenerative conditions and evaluate factors correlated with decisional regret. SUMMARY OF BACKGROUND DATA Prior research shows that one-in-five older adults regret their decision to undergo spinal deformity surgery. However, no studies have investigated decisional regret in patients with degenerative conditions. METHODS Patients who underwent cervical or lumbar spine surgery for degenerative conditions (decompression, fusion, or disk replacement) between April 2017 and December 2020 were included. The Ottawa Decisional Regret Questionnaire was implemented to assess prevalence of decisional regret. Questionnaire scores were used to categorize patients into low (<40) or medium/high (≥40) decisional regret cohorts. Patient-reported outcome measures (PROMs) included the Oswestry Disability Index, Patient-reported Outcomes Measurement Information System, Visual Analog Scale (VAS) Back/Leg/Arm, and Neck Disability Index at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) timepoints. Differences in demographics, operative variables, and PROMs between low and medium/high decisional regret groups were evaluated. RESULTS A total of 295 patients were included (mean follow-up: 18.2 mo). Overall, 92% of patients agreed that having surgery was the right decision, and 90% would make the same decision again. In contrast, 6% of patients regretted the decision to undergo surgery, and 7% noted that surgery caused them harm. In-hospital complications (P=0.02) and revision fusion (P=0.026) were significantly associated with higher regret. The medium/high decisional regret group also exhibited significantly worse PROMs at long-term follow-up for all metrics except VAS-Arm, and worse achievement of minimum clinically important difference for Oswestry Disability Index (P=0.007), Patient-Reported Outcomes Measurement Information System (P<0.0001), and VAS-Leg (P<0.0001). CONCLUSIONS Higher decisional regret was encountered in the setting of need for revision fusion, increased in-hospital complications, and worse PROMs. However, 90% of patients overall were satisfied with their decision to undergo spine surgery for degenerative conditions. Current tools for assessing patient improvement postoperatively may not adequately capture the psychosocial values and patient expectations implicated in decisional regret.
Collapse
Affiliation(s)
- Omri Maayan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | - Amy Z Lu
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| |
Collapse
|
4
|
Shen J, Nemani VM, Leveque JC, Sethi R. Personalized Medicine in Orthopaedic Surgery: The Case of Spine Surgery. J Am Acad Orthop Surg 2023; 31:901-907. [PMID: 37040614 DOI: 10.5435/jaaos-d-22-00789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/01/2023] [Indexed: 04/13/2023] Open
Abstract
Personalized medicine has made a tremendous impact on patient care. Although initially, it revolutionized pharmaceutical development and targeted therapies in oncology, it has also made an important impact in orthopaedic surgery. The field of spine surgery highlights the effect of personalized medicine because the improved understanding of spinal pathologies and technological innovations has made personalized medicine a key component of patient care. There is evidence for several of these advancements to support their usage in improving patient care. Proper understanding of normative spinal alignment and surgical planning software has enabled surgeons to predict postoperative alignment accurately. Furthermore, 3D printing technologies have demonstrated the ability to improve pedicle screw placement accuracy compared with free-hand techniques. Patient-specific, precontoured rods have shown improved biomechanical properties, which reduces the risk of postoperative rod fractures. Moreover, approaches such as multidisciplinary evaluations tailored to specific patient needs have demonstrated the ability to decrease complications. Personalized medicine has shown the ability to improve care in all phases of surgical management, and several of these approaches are now readily available to orthopaedic surgeons.
Collapse
Affiliation(s)
- Jesse Shen
- From the Department of Orthopedic Surgery, Université de Montréal (Shen), the Virginia Mason Medical Center (Nemani, Leveque, and Sethi), University of Washington (Sethi)
| | | | | | | |
Collapse
|
5
|
Inose H, Kato T, Ichimura S, Nakamura H, Hoshino M, Takahashi S, Togawa D, Hirano T, Tokuhashi Y, Ohba T, Haro H, Tsuji T, Sato K, Sasao Y, Takahata M, Otani K, Momoshima S, Hirai T, Yoshii T, Takahashi K, Okawa A. Factors affecting the quality of life in the chronic phase of thoracolumbar osteoporotic vertebral fracture managed conservatively with a brace. Spine J 2023; 23:425-432. [PMID: 36400395 DOI: 10.1016/j.spinee.2022.11.012] [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: 09/06/2022] [Revised: 10/11/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND CONTEXT Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have closely investigated the factors contributing to the quality of life (QOL) in the chronic phase after thoracolumbar OVFs using detailed radiographic evaluation. PURPOSE This study aimed to identify factors associated with the QOL in the chronic phase after thoracolumbar OVF. DESIGN Post hoc analysis of a prospective randomized study. PATIENT SAMPLE Participants included 195 patients with fresh thoracolumbar OVF managed conservatively with a brace who were available for radiographic analysis 48 weeks after injury. OUTCOME MEASURES The degree of QOL impairment at 48 weeks after thoracolumbar OVF was assessed using the Japanese three-level version of the EuroQol five-dimensional questionnaire (EQ-5D) score. METHODS Univariate and multivariate regression analyses were used to evaluate the relationships between the QOL and radiographic factors. RESULTS The univariate analysis showed that age, analgesic use, T10/L5 Cobb angle on magnetic resonance imaging (MRI), subsequent vertebral fracture, and nonunion were significantly associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. The multiple regression analysis showed that nonunion, analgesic use, subsequent vertebral fracture, and sacral slope on MRI were independently associated with the EQ-5D score at 48 weeks after thoracolumbar OVF. Receiver operating characteristic analysis for the deterioration of QOL showed that the cutoff value for sacral slope on MRI was 35 degrees. CONCLUSIONS This study demonstrated that nonunion, subsequent vertebral fracture, and lower sacral slope were independently associated with poorer QOL in the chronic phase of thoracolumbar OVF managed conservatively with a brace. Therefore, improving or preventing these factors in patients with thoracolumbar OVF in the chronic phase may improve the QOL of the affected patients.
Collapse
Affiliation(s)
- Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan.
| | - Tsuyoshi Kato
- Department of Orthopaedics, Ome Municipal General Hospital, Tokyo, 198-0042, Japan; Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan
| | - Shoichi Ichimura
- Department of Orthopaedics, Kyorin University, Tokyo, 181-8611, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery, Hamamatsu University of Medicine, Shizuoka, 431-3192, Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 951-8520, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, 409-3898, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, 108-8642, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume University, Fukuoka, 830-0011, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, Graduate School, School of Medicine, St. Marianna University, Kanagawa, 216-8511, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, 060-8638, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295
| | - Suketaka Momoshima
- Department of Diagnostic Radiology, Centre for Preventive Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Centre, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan
| | - Atsushi Okawa
- Department of Orthopaedics, Graduate School, Tokyo Medical and Dental University, Tokyo, 108-0075, Japan
| |
Collapse
|
6
|
Decisional Regret Among Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity: A Single Institutional Study: Erratum. Spine (Phila Pa 1976) 2022; 47:E627. [PMID: 36342271 DOI: 10.1097/brs.0000000000004515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|