scholarly journals Outcomes and Risks With Age in Spondylolisthesis: A Comparison of the Elderly From the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Karsy ◽  
Andrew Kai-Hong Chan ◽  
Michael S Virk ◽  
Praveen V Mummaneni ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Rating Scale ◽  
Age Groups ◽  
The Elderly ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
The Impact

Abstract INTRODUCTION Degenerative lumbar spondylolisthesis affects 3% to 20% of the population with an increasing incidence of up to 30% in the elderly. The impact of age on surgical complication and patient reported outcomes (PRO) have yet to be evaluated in a modern, multicenter study. METHODS The Quality Outcomes Database (QOD) multicenter, prospective registry was used to evaluate patients from 12 US centers, including academic and private institutions, between July 2014 and June 2016 who underwent surgical treatment for grade 1 lumbar spondylolisthesis. All patients received at least 12 mo of follow-up RESULTS A total of 608 patients were divided into < 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and > 80 (n = 32) categories. Older patients showed lower body mass index (BMI) (P = .00001), increased diabetes (P = .007), coronary artery disease (P = .0001), and osteoporosis (P = .005). A lower likelihood for home disposition was seen with the elderly (89.1% in < 60 yr olds vs 75% in > 80 yr olds), with more elderly patients discharged to skilled nursing facilities or rehabilitation (P = .002). No baseline differences in PROs (Oswestry Disability Index [ODI], EQ-5D [EuroQol healthy survey], Numeric Rating Scale for leg pain [NRS-LP] and back pain [NRS-BP]) were seen among age categories. A significant improvement for all QOLs was seen regardless of age (P < .05). Minimal clinically important differences (MCID) in QOLs were seen after surgery for all age groups. No differences in hospital readmissions (30-d, 3-mo) or reoperations (30-d, 1-yr, 2-yr, and 3-yr) were seen among age groups (P < .05). CONCLUSION Despite increased presurgical comorbidities and risk, well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes without increases in complications or readmission. However, PRO do not improve to the same degree in the elderly as in younger adults. This modern, multicenter US study reflects the current use and limitation of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

scholarly journals 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

2018 ◽  
Vol 44 (1) ◽  
pp. E3 ◽  
Author(s):  
Andrew K. Chan ◽  
Erica F. Bisson ◽  
Mohamad Bydon ◽  
Steven D. Glassman ◽  
Kevin T. Foley ◽  
...  
Keyword(s):  
Rating Scale ◽  
Patient Reported Outcome ◽  
Leg Pain ◽  
Neurosurgical Procedures ◽  
Quality Outcomes ◽  
Female Sex ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Prospective Longitudinal

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.

scholarly journals Addition of Fusion to Decompression for Grade I Degenerative Lumbar Spondylolisthesis is Associated With Greater Patient-Reported Outcome Improvements at Twenty-Four-Month Follow-Up: A Multicenter Study Using the Quality Outcomes Database

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jian Guan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Mohammed A Alvi ◽  
Steven D Glassman ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Primary Outcome Measure ◽  
Patient Reported Outcome ◽  
Leg Pain ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-mo outcomes for patients undergoing decompression alone vs decompression and fusion. METHODS Patients undergoing single-level surgery from 7/1/2014 to 6/30/2016 were identified. The primary outcome measure, 24-mo Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed. RESULTS Of the 608 patients (85.5% with at least 24-mo follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-mo change in ODI was significantly greater in the fusion group than the decompression-only group (−25.8 ± 20.0 vs −15.2 ± 19.8, P < .001). Fusion remained independently associated with 24-mo ODI change in our multivariable model (B = −7.05, 95% CI 10.70-3.39, P = < .001). Patients in the fusion group were significantly more likely to reach minimal clinically important difference (MCID, 12.8 points) in ODI at 24 mo (73.3% vs 56.0%, P = < .001), and to experience significantly greater NRS back pain improvement at 24-mo follow-up (3.8 ± 3.1 vs −1.8 ± 3.9, P < .001). Fusion was also independently associated with achieving MCID for ODI at 24 mo in our logistic regression model (OR 1.767, 95% CI 1.058-2.944, P = .029). CONCLUSION The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 mo. Longer-term follow-up is warranted to assess whether this effect is sustained.

scholarly journals Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

2018 ◽  
Vol 44 (1) ◽  
pp. E2 ◽  
Author(s):  
Anthony L. Asher ◽  
Panagiotis Kerezoudis ◽  
Praveen V. Mummaneni ◽  
Erica F. Bisson ◽  
Steven D. Glassman ◽  
...  
Keyword(s):  
Rating Scale ◽  
Degenerative Spondylolisthesis ◽  
Minimum Clinically Important Difference ◽  
Leg Pain ◽  
Satisfaction Scale ◽  
Quality Outcomes ◽  
Clinically Important Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

OBJECTIVEPatient-reported outcomes (PROs) play a pivotal role in defining the value of surgical interventions for spinal disease. The concept of minimum clinically important difference (MCID) is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment. The purpose of this study was to determine the MCID associated with surgical treatment for degenerative lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database registry from July 2014 through December 2015 for patients who underwent posterior lumbar surgery for grade I degenerative spondylolisthesis. Recorded PROs included scores on the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for leg pain (NRS-LP) and back pain (NRS-BP). Anchor-based (using the North American Spine Society satisfaction scale) and distribution-based (half a standard deviation, small Cohen’s effect size, standard error of measurement, and minimum detectable change [MDC]) methods were used to calculate the MCID for each PRO.RESULTSA total of 441 patients (80 who underwent laminectomies alone and 361 who underwent fusion procedures) from 11 participating sites were included in the analysis. The changes in functional outcome scores between baseline and the 1-year postoperative evaluation were as follows: 23.5 ± 17.4 points for ODI, 0.24 ± 0.23 for EQ-5D, 4.1 ± 3.5 for NRS-LP, and 3.7 ± 3.2 for NRS-BP. The different calculation methods generated a range of MCID values for each PRO: 3.3–26.5 points for ODI, 0.04–0.3 points for EQ-5D, 0.6–4.5 points for NRS-LP, and 0.5–4.2 points for NRS-BP. The MDC approach appeared to be the most appropriate for calculating MCID because it provided a threshold greater than the measurement error and was closest to the average change difference between the satisfied and not-satisfied patients. On subgroup analysis, the MCID thresholds for laminectomy-alone patients were comparable to those for the patients who underwent arthrodesis as well as for the entire cohort.CONCLUSIONSThe MCID for PROs was highly variable depending on the calculation technique. The MDC seems to be a statistically and clinically sound method for defining the appropriate MCID value for patients with grade I degenerative lumbar spondylolisthesis. Based on this method, the MCID values are 14.3 points for ODI, 0.2 points for EQ-5D, 1.7 points for NRS-LP, and 1.6 points for NRS-BP.

Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis?

2021 ◽  
pp. 1-8
Author(s):  
Andrew K. Chan ◽  
Praveen V. Mummaneni ◽  
John F. Burke ◽  
Rory R. Mayer ◽  
Erica F. Bisson ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Rating Scale ◽  
Lumbar Fusion ◽  
Radiographic Appearance ◽  
Lumbar Decompression ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
The Impact

OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors’ aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)–back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to −2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.

Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database

Neurosurgery ◽  
2018 ◽  
Vol 86 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Andrew K Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Back Pain ◽  
Randomized Clinical Trials ◽  
Rating Scale ◽  
Leg Pain ◽  
Obese Patients ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Nonobese Patients ◽  
The Impact

Abstract BACKGROUND Given recent differing findings following 2 randomized clinical trials on degenerative lumbar spondylolisthesis (DLS) surgery, there is a need to better define how subsets of patients fare following surgery. OBJECTIVE To investigate the impact of obesity on patient-reported outcomes (PROs) following DLS surgery. METHODS A total of 12 high-enrolling sites were queried, and we found 797 patients undergoing surgery for grade 1 DLS. For univariate comparisons, patients were stratified by BMI ≥ 30 kg/m2 (obese) and &lt; 30 kg/m2 (nonobese). Baseline, 3-mo, and 12-mo follow-up parameters were collected. PROs included the North American Spine Society satisfaction questionnaire, numeric rating scale (NRS) back pain, NRS leg pain, Oswestry Disability Index (ODI), and EuroQoL-5D (EQ-5D) Questionnaire. RESULTS We identified 382 obese (47.9%) and 415 nonobese patients (52.1%). At baseline, obese patients had worse NRS back pain, NRS leg pain, ODI, and EQ-5D scores (P &lt; .001, P = .01, P &lt; .001, and P = .02, respectively). Both cohorts improved significantly for back and leg pain, ODI, and EQ-5D at 12 mo (P &lt; .001). At 12 mo, similar proportions of obese and nonobese patients responded that surgery met their expectations (62.6% vs 67.4%, P = .24). In multivariate analyses, BMI was independently associated with worse NRS leg pain and EQ-5D at 12 mo (P = .01 and P &lt; .01, respectively) despite adjusting for baseline differences. CONCLUSION Obesity is associated with inferior leg pain and quality of life—but similar back pain, disability, and satisfaction—12 mo postoperatively. However, obese patients achieve significant improvements in all PRO metrics at 12 mo.

scholarly journals Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Kai-Ming G Fu ◽  
Paul Park ◽  
Leslie Robinson ◽  
...  
Keyword(s):  
Sexual Function ◽  
Sexual Life ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Negative Effect ◽  
American Society ◽  
Lumbar Spondylolisthesis ◽  
American Society Of Anesthesiologists ◽  
The Impact

Abstract INTRODUCTION There is a paucity of investigation on the impact of spondylolisthesis surgery on back-pain related sexual inactivity. To this end, we utilized the prospective Quality Outcomes Database (QOD) registry to investigate factors predictive of improved sex life following surgery. METHODS This was an analysis of a prospective registry of 608 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Of these, 218 patients were included who were sexually active and had both baseline and 24-mo sexual function follow-up. Baseline variables were collected. Outcomes were collected at 24 mo. Sexual function was assessed by the associated question in the Oswestry Disability Index, “With regards to pain, how would you say your sex life is?” Outcomes were dichotomized into patients who had improved sexual function and those who had same or worse sexual function. RESULTS Mean age was 58.0 ± 11.0 yr and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had an impaired sex life. At final follow-up, 130 patients (73.0% of the 178 impaired) had an improved sex life. In univariate comparisons, those with improved sexual life had lower body mass index (BMI) (29.6 ± 5.5 vs 34.4 ± 6.0; P < .001) and a lower proportion of American Society of Anesthesiologists' grades 3 or 4 (33.1%% vs 54.2%; P = .01). Following surgery, those with improved sex lives noted higher satisfaction following surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In adjusted analyses, lower BMI was associated with an improved sex life at 24 mo (OR = 1.14; 95% CI [1.05-1.20]; P < .001). CONCLUSION Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report an improvement in sex life postoperatively. Improvement in sex life was associated with significantly greater satisfaction with surgery. Lower BMI was predictive of improved sex life postoperatively.

Predictors of the Best Outcomes Following Minimally Invasive Surgery for Grade 1 Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Back Pain ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Rating Scale ◽  
College Education ◽  
Leg Pain ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION The factors driving the best outcomes following minimally invasive surgery (MIS) for degenerative lumbar spondylolisthesis (DLS) are not clearly elucidated. This study investigates the factors that drive the best patient reported outcomes (PRO) following MIS for DLS. METHODS A total of 608 patients from the prospective Quality Outcomes Database (QOD) Lumbar Spondylolisthesis Registry underwent surgery for grade 1 DLS of whom 259 underwent surgery with MIS techniques [187 fusions (72.2%)]. Surgeries were classified as MIS if any of the following were involved: MIS laminectomy, MIS pedicle screws, MIS interbody grafts, or percutaneous screws. Outcomes were assessed at 24 mo postoperatively. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) Back Pain, NRS Leg Pain, EuroQoL-5D (EQ-5D) Questionnaire, and North American Spine Society (NASS) Satisfaction Questionnaire. Multivariate models were constructed adjusting for patient characteristics, presentation characteristics, surgical variables, socioeconomic characteristics, and baseline PRO values. RESULTS The mean age of the MIS cohort was 64.2 ± 11.5 yr [148 (57.1%) women and 111 (42.9%) men]. In multivariate analyses, aside from baseline PRO values, only 3 factors were significantly associated with multiple 24-mo PRO change scores: employment, age, and the addition of fusion to surgery. Employment was associated with superior postoperative ODI (ß-7.8; 95% CI [−12.9- −2.6]; P = .003), NRS back pain (ß-1.2; 95% CI [−2.1- −0.4]; P = 0.004), EQ-5D (ß0.1; 95% CI [0.01-0.1]; P = .03), and NASS satisfaction (OR = 0.27; 95% CI [0.12-0.58]; P < .001). Increasing age was associated with superior NRS leg pain (ß-0.1; 95% CI [minus;0.1- minus;0.01]; P = .03) and NASS satisfaction (OR = 0.95; 95% CI [0.92-0.99]; P = .02). The addition of a fusion was associated with superior ODI (ß-6.7; 95% CI [minus;12.7- minus;0.7]; P = .03), NRS back pain (ß-1.1; 95% CI [minus;2.1- minus;0.2]; P = .02), and NASS satisfaction (OR = 0.28; 95% CI [0.12-0.62]; P = .002). CONCLUSION Preoperative active employment, at least 4 yr of college education, and surgeries including a fusion were significant predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain and satisfaction.

scholarly journals Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the Quality Outcomes Database

2020 ◽  
Vol 48 (5) ◽  
pp. E5 ◽  
Author(s):  
Anthony M. DiGiorgio ◽  
Praveen V. Mummaneni ◽  
Paul Park ◽  
Andrew K. Chan ◽  
Erica F. Bisson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Back Pain ◽  
Return To Work ◽  
Rating Scale ◽  
College Education ◽  
Quality Outcomes ◽  
Data Set ◽  
Number Of Patients ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

OBJECTIVEReturn to work (RTW) and satisfaction are important outcome measures after surgery for degenerative spine disease. The authors queried the prospective Quality Outcomes Database (QOD) to determine if RTW correlated with patient satisfaction.METHODSThe QOD was queried for patients undergoing surgery for degenerative lumbar spondylolisthesis. The primary outcome of interest was correlation between RTW and patient satisfaction, as measured by the North American Spine Society patient satisfaction index (NASS). Secondarily, data on satisfied patients were analyzed to see what patient factors correlated with RTW.RESULTSOf 608 total patients in the QOD spondylolisthesis data set, there were 292 patients for whom data were available on both satisfaction and RTW status. Of these, 249 (85.3%) were satisfied with surgery (NASS score 1–2), and 224 (76.7%) did RTW after surgery. Of the 68 patients who did not RTW after surgery, 49 (72.1%) were still satisfied with surgery. Of the 224 patients who did RTW, 24 (10.7%) were unsatisfied with surgery (NASS score 3–4). There were significantly more people who had an NASS score of 1 in the RTW group than in the non-RTW group (71.4% vs 42.6%, p < 0.05). Failure to RTW was associated with lower level of education, worse baseline back pain (measured with a numeric rating scale), and worse baseline disability (measured with the Oswestry Disability Index [ODI]).CONCLUSIONSThere are a substantial number of patients who are satisfied with surgery even though they did not RTW. Patients who were satisfied with surgery and did not RTW typically had worse preoperative back pain and ODI and typically did not have a college education. While RTW remains an important measure after surgery, physicians should be mindful that patients who do not RTW may still be satisfied with their outcome.

Predictors of the Best Outcomes Following Minimally Invasive Surgery for Grade 1 Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Andrew K Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Back Pain ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Leg Pain ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract BACKGROUND The factors driving the best outcomes following minimally invasive surgery (MIS) for grade 1 degenerative lumbar spondylolisthesis are not clearly elucidated. OBJECTIVE To investigate the factors that drive the best 24-mo patient-reported outcomes (PRO) following MIS surgery for grade 1 degenerative lumbar spondylolisthesis. METHODS A total of 259 patients from the Quality Outcomes Database lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis with MIS techniques (188 fusions, 72.6%). Twenty-four-month follow-up PROs were collected and included the Oswestry disability index (ODI) change (ie, 24-mo minus baseline value), numeric rating scale (NRS) back pain change, NRS leg pain change, EuroQoL-5D (EQ-5D) questionnaire change, and North American Spine Society (NASS) satisfaction questionnaire. Multivariable models were constructed to identify predictors of PRO change. RESULTS The mean age was 64.2 ± 11.5 yr and consisted of 148 (57.1%) women and 111 (42.9%) men. In multivariable analyses, employment was associated with superior postoperative ODI change (β-7.8; 95% CI [−12.9 to −2.6]; P = .003), NRS back pain change (β −1.2; 95% CI [−2.1 to −0.4]; P = .004), EQ-5D change (β 0.1; 95% CI [0.01-0.1]; P = .03), and NASS satisfaction (OR = 3.7; 95% CI [1.7-8.3]; P &lt; .001). Increasing age was associated with superior NRS leg pain change (β −0.1; 95% CI [−0.1 to −0.01]; P = .03) and NASS satisfaction (OR = 1.05; 95% CI [1.01-1.09]; P = .02). Fusion surgeries were associated with superior ODI change (β −6.7; 95% CI [−12.7 to −0.7]; P = .03), NRS back pain change (β −1.1; 95% CI [−2.1 to −0.2]; P = .02), and NASS satisfaction (OR = 3.6; 95% CI [1.6-8.3]; P = .002). CONCLUSION Preoperative employment and surgeries, including a fusion, were predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain improvement and satisfaction.

scholarly journals The Outcomes of Cochlear Implantation in Elderly Patients: A Single United Kingdom Center Experience

2020 ◽  
pp. 014556132091066
Author(s):  
Nikul Amin ◽  
Gentle Wong ◽  
Terry Nunn ◽  
Dan Jiang ◽  
Irumee Pai
Keyword(s):  
United Kingdom ◽  
Health Status ◽  
Speech Perception ◽  
Elderly Patients ◽  
Cochlear Implantation ◽  
Age Groups ◽  
The Elderly ◽  
Glasgow Benefit Inventory ◽  
Significant Difference ◽  
Patient Reported

Objectives: The average life expectancy in the United Kingdom is currently nearly 80 years for a newborn baby with nearly 15% of the population, by 2040, being >75 years old. Hearing impairment is a common disability in the elderly individual, and there have been significant drives to support this population to lead longer and healthier working lives. We aimed to assess the long-term audiological and health-related quality-of-life benefits of cochlear implants (CI) in elderly individuals. Methods: A retrospective and cross-sectional study of patients who received a CI at ≥70 years. Data extracted included speech perception scores, adverse events, telephone use, and patient-reported outcome measures using the Glasgow Benefit Inventory questionnaire with a minimum of 12 months follow-up. Results: Sixty-four patients aged ≥70 years received a unilateral CI. A significant improvement in speech perception scores in all conditions was noted with no significant difference between differing age groups. Glasgow Benefit Inventory scores showed a significant positive impact on patients’ lives and their health status, with no significant difference between the differing age groups. Conclusions: Cochlear implantation is a safe and well-tolerated procedure in the elderly patients with significant improvements observed in audiological performance, health status, and social interactions.

Sign in / Sign up

Export Citation Format

Share Document