The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

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Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20592 ◽

2021 ◽

Vol 34 (1) ◽

pp. 73-82 ◽

Cited By ~ 1

Author(s):

Christine Park ◽

Alessandra N. Garcia ◽

Chad Cook ◽

Christopher I. Shaffrey ◽

Oren N. Gottfried

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Normal Weight ◽

Lumbar Spine Surgery ◽

Morbidly Obese ◽

Lumbar Surgery ◽

Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

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Influence of dynamic preoperative body mass index changes on patient-reported outcomes after surgery for degenerative lumbar spine disease

Neurosurgical Review ◽

10.1007/s10143-020-01454-5 ◽

2020 ◽

Author(s):

Alessandro Siccoli ◽

Marc L. Schröder ◽

Victor E. Staartjes

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Preoperative Weight Loss ◽

Patient Reported ◽

Preoperative Weight

AbstractPsychological factors demonstrably and often massively influence outcomes of degenerative spine surgery, and one could hypothesize that preoperative weight loss may correlate with motivation and lifestyle adjustment, thus leading to potentially enhanced outcomes. We aimed to evaluate the effect of preoperative weight loss or gain, respectively, on patient-reported outcomes after lumbar spine surgery. Weight loss was defined as a BMI decrease of ≤ − 0.5 kg/m2 over a period of at least 1 month, and weight gain as a BMI increase of ≥ 0.5 kg/m2 in the same time period, respectively. The primary endpoint was set as the achievement of the minimum clinically important difference (MCID) in the ODI at 1 or 2 years postoperatively. A total of 154 patients were included. Weight loss (odds ratio (OR): 1.18, 95% confidence interval (CI): 0.52 to 2.80) and weight gain (OR: 1.03, 95% CI: 0.43 to 2.55) showed no significant influence on MCID achievement for ODI compared to a stable BMI. The same results were observed when analysing long-term NRS-BP and NRS-LP. Regression analysis showed no correlation between BMI change and PROM change scores for any of the three PROMs. Adjustment for age and gender did not alter results. Our findings suggest that both preoperative weight loss and weight gain may have no measurable effect on long-term postoperative outcome compared to a stable BMI. Weight loss preoperatively—as a potential surrogate sign of patient motivation and lifestyle change—may thus not influence postoperative outcomes.

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Impact of Gender Disparities on Short-Term and Long-Term Patient Reported Outcomes and Satisfaction Measures After Elective Lumbar Spine Surgery: A Single Institutional Study of 384 Patients

World Neurosurgery ◽

10.1016/j.wneu.2017.07.082 ◽

2017 ◽

Vol 107 ◽

pp. 952-958 ◽

Cited By ~ 14

Author(s):

Aladine A. Elsamadicy ◽

Gireesh B. Reddy ◽

Gautum Nayar ◽

Amanda Sergesketter ◽

Rasheedat Zakare-Fagbamila ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Gender Disparities ◽

Lumbar Spine Surgery ◽

Short Term ◽

Patient Reported ◽

Satisfaction Measures

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The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyaa427 ◽

2020 ◽

Author(s):

Oliver G S Ayling ◽

Tamir Ailon ◽

John T Street ◽

Nicolas Dea ◽

Greg McIntosh ◽

...

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Short Form ◽

Research Network ◽

Lumbar Spine Surgery ◽

Degenerative Disorders ◽

Patient Reported ◽

Euroqol 5D

Abstract BACKGROUND Perioperative adverse events (AEs) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. OBJECTIVE To examine perioperative AEs and their impact on outcome after lumbar spine surgery. METHODS A total of 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3, 12, and 24 mo postoperatively included the Owestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary scales, visual analog scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction. RESULTS AEs occurred in 767 (21.6%) patients, and 85 (2.4%) patients suffered major AEs. Patients with major AEs had worse ODI scores and did not reach minimum clinically important differences at 2 yr (no AE: 25.7 ± 19.2, major: 36.4 ± 19.1, P < .001). Major AEs were associated with worse ODI scores on multivariable linear regression (P = .011). PCS scores were lower after major AEs (43.8 ± 9.5, vs 37.7 ± 20.3, P = .002). On VAS leg and back and EQ5D, the 2-yr outcomes were significantly different between the major and no AE groups (<0.01), but these differences were small (VAS leg: 3.4 ± 3.0 vs 4.0 ± 3.3; VAS back: 3.5 ± 2.7 vs 4.5 ± 2.6; EQ5D: 0.75 ± 0.2 vs 0.64 ± 0.2). SF12 MCS scores were not different. Rates of satisfaction were lower after major AEs (no AE: 84.6%, major: 72.3%, P < .05). CONCLUSION Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing AEs.

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