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

Thumbnail Image
View / Download865.27 KB

Date

2020-10

Authors

Journal Title

Journal ISSN

Volume Title

Repository Usage Stats

12
views
29
downloads

Citation Stats

Abstract

Background

The impact of symptom characteristics on outcomes of spine surgery remains elusive.

Objective

To determine the impact of symptom location, severity, and duration on outcomes following lumbar spine surgery.

Methods

We queried the Quality Outcomes Database (QOD) for patients undergoing elective lumbar spine surgery for lumbar degenerative spine disease. Multivariable regression was utilized to determine the impact of preoperative symptom characteristics (location, severity, and duration) on improvement in disability, quality of life, return to work, and patient satisfaction at 1 yr. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom.

Results

A total of 22 022 subjects were analyzed. On adjusted analysis, we found patients with predominant leg pain were more likely to be satisfied (P < .0001), achieve minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to work (P = .03) at 1 yr following surgery without significant difference in Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal leg and back pain were more likely to be satisfied (P < .0001), but showed no significant difference in achieving MCID (P = .22) or return to work (P = .07). Baseline numeric rating scale-leg pain and symptom duration were most important predictors of achieving MCID and change in EQ-5D. Predominant symptom was not found to be an important determinant of return to work. Worker's compensation was found to be most important determinant of satisfaction and return to work.

Conclusion

Predominant symptom location is a significant determinant of functional outcomes following spine surgery. However, pain severity and duration have higher predictive importance. Return to work is more dependent on sociodemographic features as compared to symptom characteristics.

Type

Journal article

Department

Description

Provenance

Subjects

Lumbar Vertebrae, Humans, Low Back Pain, Treatment Outcome, Neurosurgical Procedures, Quality of Life, Databases, Factual, Adult, Aged, Middle Aged, Patient Satisfaction, Female, Male, Intervertebral Disc Degeneration, Symptom Assessment, Patient Reported Outcome Measures

Citation

Permalink

https://hdl.handle.net/10161/28130

Published Version (Please cite this version)

10.1093/neuros/nyaa240

Publication Info

Devin, Clinton J, Anthony L Asher, Kristin R Archer, Anshit Goyal, Inamullah Khan, Panagiotis Kerezoudis, Mohammed Ali Alvi, Jacquelyn S Pennings, et al. (2020). Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery. Neurosurgery, 87(5). pp. 1037–1045. 10.1093/neuros/nyaa240 Retrieved from https://hdl.handle.net/10161/28130.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Collections

Scholarly Articles
Full item page

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.