Impact of Preoperative Opioid Use on Postoperative Patient-reported Outcomes in Lumbar Spine Surgery Patients

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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Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery

Neurosurgery ◽

10.1093/neuros/nyaa240_s040 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S40-S40

Author(s):

Clinton J Devin ◽

Anthony L Asher ◽

Kristin R Archer ◽

Anshit Goyal ◽

Inamullah Khan ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Patient Reported

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The association between patient rating of their spine surgeon and quality of postoperative outcome

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20478 ◽

2020 ◽

pp. 1-7

Author(s):

Nicholas M. Rabah ◽

Hammad A. Khan ◽

Jay M. Levin ◽

Robert D. Winkelman ◽

Thomas E. Mroz ◽

...

Keyword(s):

Mental Health ◽

Patient Satisfaction ◽

Lumbar Spine ◽

Linear Regression ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Linear Regression Analysis ◽

Lumbar Spine Surgery ◽

Patient Rating ◽

Patient Reported

OBJECTIVEThe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes.METHODSAll patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders.RESULTSThe study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year.CONCLUSIONSThe authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients’ satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.

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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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The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: Three- and Twelve-Month Results

Neurosurgery ◽

10.1093/neuros/nyz310_115 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Juneyoung L Chavez ◽

Christina A Porucznik ◽

Lisa H Gren ◽

Jian Guan ◽

Evan Joyce ◽

...

Keyword(s):

Lumbar Spine ◽

Treatment Group ◽

Spine Surgery ◽

Stress Reduction ◽

Postoperative Outcomes ◽

Prescription Opioid ◽

Lumbar Spine Surgery ◽

Opioid Use ◽

Patient Reported ◽

Change In Mean

Abstract INTRODUCTION Prescription opioids negatively affect postoperative outcomes after lumbar spine surgery, and according to the CDC, the drug overdose epidemic has been exacerbated by the involvement of prescription medications. Thus, alternatives for pain control are imperative. Mindfulness-based stress reduction (MBSR) has been associated with improved activity, mood, walking, and work in opioid-using chronic pain patients. Prospective studies utilizing preoperative MBSR to impact postoperative outcomes in degenerative lumbar spine surgery are lacking. METHODS The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. A total of 3- and 12-mo postoperative patient-reported outcomes for pain, disability, quality of life, and prescription opioid use were compared. Univariate linear regression was used to assess if MBSR use was a significant predictor of outcomes. RESULTS At 3 mo, follow-up was 87.5% and 95.8% in the comparison and treatment groups, respectively. Mean ODI was significantly lower (P = .032), mean PROMIS-PF was significantly higher (P = .002), and mean PROMIS-PI was significantly lower (P = .025) in the treatment group. Also, change in mean PROMIS-PF and change in mean PROMIS-PI were significantly greater (P = .002, P = .038). MBSR use was a significant predictor of change in PROMIS-PF (P = .003). At 12 mo, follow-up was 58.3% and 83.3% in the comparison and treatment groups, respectively. Mean PROMIS-PI was significantly lower (P = .011) and change in mean PROMIS-PI was significantly greater (P = .003) in the treatment group. MBSR use was a significant predictor of change in PROMIS-PI (P = .004). CONCLUSION At 3 mo, the treatment group experienced significantly lower disability, higher physical function, and lower pain interference. At 12 mo, only lower pain interference persisted. Further clinical trials are needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.

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Diabetes is associated with greater leg pain and worse patient-reported outcomes at 1 year after lumbar spine surgery

Scientific Reports ◽

10.1038/s41598-021-87615-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kosei Nagata ◽

Hideki Nakamoto ◽

Masahiko Sumitani ◽

So Kato ◽

Yuichi Yoshida ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Postoperative Recovery ◽

Diabetic Group ◽

Leg Pain ◽

Lumbar Spine Surgery ◽

Patient Reported ◽

Patients With Diabetes ◽

The Impact

AbstractAlthough patients with diabetes reportedly have more back pain and worse patient-reported outcomes than those without diabetes after lumbar spine surgery, the impact of diabetes on postoperative recovery in pain or numbness in other regions is not well characterized. In this study, the authors aimed to elucidate the impact of diabetes on postoperative recovery in pain/numbness in four areas (back, buttock, leg, and sole) after lumbar spine surgery. The authors retrospectively reviewed 993 patients (152 with diabetes and 841 without) who underwent decompression and/or fixation within three levels of the lumbar spine at eight hospitals during April 2017–June 2018. Preoperative Numerical Rating Scale (NRS) scores in all four areas, Oswestry Disability Index (ODI), and Euro quality of life 5-dimension (EQ-5D) were comparable between the groups. The diabetic group showed worse ODI/EQ-5D and greater NRS scores for leg pain 1 year after surgery than the non-diabetic group. Although other postoperative NRS scores tended to be higher in the diabetic group, the between-group differences were not significant. Diabetic neuropathy caused by microvascular changes may induce irreversible nerve damage especially in leg area. Providers can use this information when counseling patients with diabetes about the expected outcomes of spine surgery.

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