scholarly journals Does Smoking Affect Short-Term Patient-Reported Outcomes After Lumbar Decompression?

2020 ◽  
pp. 219256822092579
Author(s):  
Dhruv K. C. Goyal ◽  
Srikanth N. Divi ◽  
Daniel R. Bowles ◽  
Victor E. Mujica ◽  
I. David Kaye ◽  
...  
Keyword(s):  
Smoking Status ◽  
Short Form ◽  
Linear Regression Analysis ◽  
Physical Component Score ◽  
Decompression Surgery ◽  
Short Term ◽  
Component Score ◽  
Lumbar Decompression ◽  
Patient Reported ◽  
Lumbar Decompression Surgery

Study Design: Retrospective cohort study. Objective: The goal of this study was to determine how smoking status influences patient-reported outcome measurements (PROMs) in patients undergoing lumbar decompression surgery. Methods: Patients undergoing lumbar decompression between 1 to 3 levels at a single-center, academic hospital were retrospectively identified. Patients <18 years old, and those undergoing surgery for infection, trauma, tumor, or revision, with less than 12 months of follow-up were excluded. Patients were divided into 3 groups: (1) never smokers (NSs); (2) current smokers (CSs); and (3) former smokers (FSs). PROMs analyzed included the Physical Component Score and Mental Component Score of the Short Form-12 Health Survey, the Oswestry Disability Index, and Visual Analogue Scale Back and Leg pain scores. One-way ANOVA was used to compare preoperative and postoperative scores between smoking groups, and multiple linear regression analysis was performed to determine whether smoking status predicted change in each outcome score, controlling for factors such as age, sex, body mass index, and other clinical variables. A P value <.05 was considered to be significant. Results: A total of 195 patients were included in the final cohort, with 121 (62.1%) patients in the NS group, 22 (11.3%) in the CS group, and 52 (26.6%) in the FS group. There were no significant differences between groups at baseline or postoperatively. Smoking status was also not a significant predictor of change in any outcome scores over time on multivariate analysis. Conclusion: These results suggest that smoking status does not significantly affect short-term complications or outcomes in patients undergoing lumbar decompression surgery.

scholarly journals P.136 Quantifying potential sources of delay in surgical management of cervical spondylotic myelopathy

2018 ◽  
Vol 45 (s2) ◽  
pp. S52-S52
Author(s):  
V Chan ◽  
A Nataraj
Keyword(s):  
Quality Of Life ◽  
Cervical Spondylotic Myelopathy ◽  
Short Form ◽  
Research Network ◽  
Physical Component Score ◽  
Decompression Surgery ◽  
Duration Of Symptoms ◽  
Component Score

Background: Cervical spondylotic myelopathy is a degenerative condition with a variable clinical course. We aim to quantify the sources of potential delay in management and understand how the timing of these events may affect quality of life measures. Methods: The Canadian Spine Outcomes Research Network Registry was used to identify patients older than 18 years of age and have received cervical decompression surgery from January 1, 2013 to March 1, 2016. The primary outcome was the Short Form-12 Physical Component Score at 12-month follow-up. Four time groups were identified: 1) duration of symptoms, 2) time awaiting surgical consult, 3) time spent monitoring symptoms, and 4) time awaiting surgery. -Multivariate regression was used for analysis. Results: A total of 208 patients were identified. The mean age was 59.5 years. 61.53% of patients had symptoms for >12 months at initial consult. Mean time awaiting surgical consult, monitoring symptoms, and awaiting surgery was 77.2, 60.9, and 46.9 days, respectively. Time awaiting surgery (β=-0.032, p=0.04) was a significant factor for change in Physical Component Score. Conclusions: We found time awaiting surgery to be a significant factor on PSC score at 12-month follow-up. Increased time awaiting surgery may result in negative impacts on quality of life outcomes.

The change in postoperative opioid prescribing after lumbar decompression surgery following state-level opioid prescribing reform

2021 ◽  
pp. 1-9
Author(s):  
Robert D. Winkelman ◽  
Michael D. Kavanagh ◽  
Joseph E. Tanenbaum ◽  
Dominic W. Pelle ◽  
Edward C. Benzel ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Patient Reported Outcomes ◽  
Hospital Readmissions ◽  
State Level ◽  
Decompression Surgery ◽  
Opioid Prescribing ◽  
Lumbar Decompression ◽  
Patient Reported ◽  
Ed Visits ◽  
Lumbar Decompression Surgery

OBJECTIVE On August 31, 2017, the state of Ohio implemented legislation limiting the dosage and duration of opioid prescriptions. Despite the widespread adoption of such restrictions, few studies have investigated the effects of these reforms on opioid prescribing and patient outcomes. In the present study, the authors aimed to evaluate the effect of recent state-level reform on opioid prescribing, patient-reported outcomes (PROs), and postoperative emergency department (ED) visits and hospital readmissions after elective lumbar decompression surgery. METHODS This study was a retrospective cohort study of patients who underwent elective lumbar laminectomy for degenerative disease at one of 5 hospitals within a single health system in the years prior to and after the implementation of the statewide reform (September 1, 2016–August 31, 2018). Patients were classified according to the timing of their surgery relative to implementation of the prescribing reform: before reform (September 1, 2016–August 31, 2017) or after reform (September 1, 2017– August 31, 2018). The outcomes of interest included total outpatient opioids prescribed in the 90 days following discharge from surgery as measured in morphine-equivalent doses (MEDs), total number of opioid refill prescriptions written, patient-reported pain at the first postoperative outpatient visit as measured by the Numeric Pain Rating Scale, improvement in patient-reported health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System–Global Health (PROMIS-GH) questionnaire, and ED visits or hospital readmissions within 90 days of surgery. RESULTS A total of 1031 patients met the inclusion criteria for the study, with 469 and 562 in the before- and after-reform groups, respectively. After-reform patients received 26% (95% CI 19%–32%) fewer MEDs in the 90 days following discharge compared with the before-reform patients. No significant differences were observed in the overall number of opioid prescriptions written, PROs, or postoperative ED or hospital readmissions within 90 days in the year after the implementation of the prescribing reform. CONCLUSIONS Patients undergoing surgery in the year after the implementation of a state-level opioid prescribing reform received significantly fewer MEDs while reporting no change in the total number of opioid prescriptions, PROs, or postoperative ED visits or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions written for acute pain may decrease patient opioid exposure without negatively impacting patient outcomes after lumbar decompression surgery.

scholarly journals Change in Patient-Reported Outcome Measures as Predictors of Revision Lumbar Decompression Procedures

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 863-870
Author(s):  
Michael T. Nolte ◽  
Elliot D.K. Cha ◽  
Conor P. Lynch ◽  
Kevin C. Jacob ◽  
Madhav R. Patel ◽  
...  
Keyword(s):  
At Risk ◽  
Risk Factor ◽  
Outcome Measures ◽  
Short Form ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Physical Component Score ◽  
Lumbar Decompression ◽  
Patient Reported ◽  
Primary Procedure

Objective: To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).Methods: Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.Results: The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).Conclusion: LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.

The efficacy of coccygectomy in patients with persistent coccydynia

2021 ◽  
Vol 103-B (3) ◽  
pp. 542-546
Author(s):  
Stefan Milosevic ◽  
Gustav Ø. Andersen ◽  
Mads M. Jensen ◽  
Mikkel M. Rasmussen ◽  
Leah Carreon ◽  
...  
Keyword(s):  
Short Form ◽  
Demographic Data ◽  
Nonoperative Treatment ◽  
Physical Component Score ◽  
Component Score ◽  
Spine Registry ◽  
Sf 36 ◽  
Patient Reported ◽  
Five Dimension ◽  
One Year

Aims The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. Methods The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. Results A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. Conclusion Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542–546.

BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Srikanth N. Divi ◽  
Dhruv K.C. Goyal ◽  
Justin D. Stull ◽  
Parth Kothari ◽  
Fortunato G. Padua ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Decompression Surgery ◽  
Lumbar Decompression ◽  
Patient Reported ◽  
Lumbar Decompression Surgery

The Validity of the Quick-FAAM in Patients Seeking Treatment for an Acute or Subacute Foot or Ankle Condition

2017 ◽  
Vol 26 (3) ◽  
Author(s):  
Johanna M. Hoch ◽  
Jamie L. Legner ◽  
Christina Lorete ◽  
Matthew C. Hoch
Keyword(s):  
Internal Consistency ◽  
Treatment Effectiveness ◽  
Short Form ◽  
Physical Component Score ◽  
Future Research ◽  
Minimal Detectable Change ◽  
Cross Sectional ◽  
Foot Health ◽  
Component Score ◽  
Patient Reported

Context: Documented barriers to implementation of patient-reported outcome instruments (PROs) in practice include administration and scoring time. The Quick Foot and Ankle Ability Measure (Quick-FAAM) was developed to decrease these barriers; however, the clinometric properties in an acute population are unknown. Purpose: To determine the internal consistency, validity, and the floor and ceiling effects of the Quick-FAAM in patients seeking treatment for an acute or subacute ankle or foot health condition. Study Design: Cross-Sectional. Setting: Healthcare facilities.Patients: 50 patients (20.3 ± 2.2 y, 177.9 ± 10.7 cm, 80 ± 19.4 kg) seeking treatment for an acute or subacute ankle or foot condition. Main Outcome Measures: Each patient completed a demographic and health-history questionnaire followed by 5 PROs: the Quick-FAAM, the FAAM-Activities of Daily Living (ADL), FAAM-Sport, the modified Disablement in the Physically Active Scale (mDPA), the Short-Form 12 (SF-12) and the PROMISv1.2 Physical Function (PROMIS-PF). Cronbach alpha was used to determine internal consistency and Spearman’s rank correlations were performed to examine the relationship between the Quick-FAAM and all other outcomes. Results: The Quick-FAAM was very strongly correlated with the FAAM-Total (r = .91, r2 = .83, P < .001), FAAM-ADL (r = .83, r2 = .69, P < .001), FAAM-Sport (r = .89, r2 = .79, P < .001), SF12-Physical Component Score (PCS, r = .74, r2 = .55, P < .001), mDPA-PCS (r = -.83, r2 = .69, P < .001) and PROMIS PF (r = .85, r2 = .72, P < .001). There was a weak or no relationship with the SF12-Mental Component Score (MCS, r = .04, r2 = .00, P < .001) and the mDPA-MCS (r = -.35, r2 = .12, P < .001). A total of 8% (n = 4) of the patients scored a 0, and 2% (n = 1) patients scored a 48. Conclusion: The Quick-FAAM demonstrated good convergent and divergent validity along with good internal consistency. There was no evidence of a floor or ceiling effect. Therefore, the Quick-FAAM should be considered for use in practice when determining treatment effectiveness for patients with acute or subacute ankle or foot health conditions. Future research should determine the test-retest reliability and the minimal detectable change of this instrument.

scholarly journals Moving toward better health: exercise practice is associated with improved outcomes after spine surgery in people with degenerative lumbar conditions

2021 ◽  
Vol 64 (4) ◽  
pp. E419-E427
Author(s):  
Carolyn E. Schwartz ◽  
Roland B. Stark ◽  
Phumeena Balasuberamaniam ◽  
Mopina Shrikumar ◽  
Abeer Wasim ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Short Form ◽  
Patient Reported Outcome ◽  
Physical Component Score ◽  
Component Score ◽  
Patient Reported ◽  
Before And After ◽  
Main Effects

Background: Recovery and rehabilitation following surgery can take many months. Understanding what patients can do to facilitate recovery would be beneficial for spinal surgeons. This study sought to evaluate the impact of exercise practice, before and after surgery, on long-term outcomes of spine surgery in a robust clinical sample. Methods: This prospective longitudinal cohort study included adult patients undergoing spinal surgery for degenerative spinal conditions. Patients were administered a survey that included preoperative and postoperative exercise practices and the following patient-reported outcome measures: the physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-Item Short Form Survey (Rand-36), the Oswestry Disability Index (ODI) score, the Numeric Rating Scale (NRS) score for pain and the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference Short Form score. Random effects models investigated the relationship of exercise, follow-up time and their interaction in predicting each patient-reported outcome measure over time, with and without sociodemographic covariates. Results: There were 168 patients in the study sample with up to 12 months of follow-up data. Analysis revealed modest significant main effects of exercise on PCS, MCS, ODI and PROMIS scores and main effects of time on all outcomes. The exercise-by-time interaction was significant in predicting the trajectories of the ODI and MCS scores. When full models were adjusted for education and employment status, interaction effects were no longer significant, but exercise main effects remained significant for ODI score. Conclusion: Patients who engage in exercise before and after spine surgery have better mental health and spine-specific recovery trajectories than those who do not. All health care providers should encourage patients to exercise while they are waiting for surgery within preoperative limitations and as soon as they are able after surgery and to continue this over the long term.

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