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

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

Neurosurgery ◽

10.1093/neuros/nyaa427_s095 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S95-S95

Author(s):

Oliver G S Ayling ◽

Tamir Ailon ◽

John T Street ◽

Nicolas Dea ◽

Greg McIntosh ◽

...

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Patient Reported

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Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2017.12.spine171079 ◽

2018 ◽

Vol 29 (1) ◽

pp. 40-45 ◽

Cited By ~ 8

Author(s):

Aladine A. Elsamadicy ◽

Hanna Kemeny ◽

Owoicho Adogwa ◽

Eric W. Sankey ◽

C. Rory Goodwin ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Racial Disparities ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Readmission Rates ◽

Patient Reported ◽

Short And Long Term ◽

Satisfaction Measures

OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

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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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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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Patient-reported outcomes in lumbar spine surgery

Nigerian Journal of Medicine ◽

10.4103/njm.njm_208_20 ◽

2021 ◽

Vol 30 (4) ◽

pp. 353

Author(s):

ObinnaHenry Obiegbu

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Lumbar Spine Surgery ◽

Patient Reported

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P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.330 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S83-S83

Author(s):

O Ayling ◽

C FIsher

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Physical Disability ◽

Research Network ◽

Lumbar Spine Surgery ◽

Degenerative Disorders ◽

Patient Reported ◽

Euroqol 5D

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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