scholarly journals Process Evaluation of Lumbar Interbody Fusion Surgeries in Five Dutch Hospitals: A Qualitative Analysis

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 99
Author(s):  
Ruud Droeghaag ◽  
Inge J. M. H. Caelers ◽  
Aggie T. G. Paulus ◽  
Wouter L. W. van Hemert ◽  
Henk van Santbrink ◽  
...  

Background and Objectives: Only limited qualitative research concerning instrumented spine surgeries has been published, despite the increasing number of these surgeries and the evident importance of qualitative analysis of the processes surrounding these complex interventions. Current qualitative research is mainly limited to the experiences, emotions and expectations of patients. Insight into the full process, including experiences from the perspective of informal caregivers and healthcare professionals, remains scarce. Materials and Methods: Data were gathered by means of semi-structured face-to-face interviews. In total, there were 27 participants, including 11 patients, 7 informal caregivers and 9 healthcare professionals. The interview process was audiotaped, and each interview was transcribed verbatim. To systematically analyse the gathered data, software for qualitative analysis (NVivo) was used. After immersion in the raw data of transcripts and field notes, a list of broad categories for organising the data into meaningful clusters for analysis was developed. All interviews were coded by the first author, and 25% was independently assessed by the second author. Results: The results of our study describe several promoting and limiting factors concerning the process of lumbar fusion surgery from the perspective of patients, informal caregivers and healthcare providers. The most frequently mentioned promoting factors were: information and opportunities to ask questions during consultations; multidisciplinary consultations; good communication and guidance during hospitalization; and follow-up appointments. The most frequently mentioned limiting factors were: lack of educational material; lack of guidance and communication prior to, during and after hospitalisation. Conclusion: Overall, participants were satisfied with the current healthcare-process in lumbar fusion surgery. However, we found that lack of educational material and guidance during the process led to insecurity about complaints, surgery and recovery. To improve the process of lumbar interbody fusion and to increase patient satisfaction, healthcare providers should focus on guiding and educating patients and informal caregivers about the pre-operative trajectory, the surgery and the recovery. From the healthcare providers’ perspective, the process could be improved by multidisciplinary consultations and a dedicated spine team in the operation room. Although this study focusses on lumbar fusion surgery, results could be translated to other fields of spine surgery and surgery in general.

2020 ◽  
Author(s):  
Jun Li ◽  
Kai Liu ◽  
Li Yang ◽  
DEGUO WANG

Abstract Background: Approximately 4-20% patients with degenerative lumbar diseases showed persistent pain after lumbar fusion surgery that may develop into failed back surgery syndrome (FBSS), and this persistent pain may be related to the postoperative increased release of inflammatory mediators. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) can obviously reduce the intraoperative soft tissue trauma. The aim of this study is to investigate the persistent pain in the patients with degenerative lumbar diseases undergoing MIS-TLIF compared with conventional‑invasive TLIF. Material and methods: This study retrospectively included 146 patients (MIS-TLIF vs. conventional‑invasive TLIF: 56 vs. 90), and the incidence of persistent pain were evaluated. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and after operation. Results: Significantly larger number of patients undergoing conventional‑invasive TLIF showed postoperative persistent pain compared to those undergoing MIS-TLIF (4/56, 7.1% vs. 20/90, 22.2%; P < 0.05). In both treatment groups, the patients with postoperative persistent pain showed increased IL-6 and IL-1β in drainage fluid, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and the extent of postoperative persistent pain in patients with postoperative persistent pain (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative persistent pain, and MIS-TLIF may reduce this inflammatory accumulation at the surgical site and subsequently reduce the risk of persistent pain.


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