What determines patient satisfaction after surgery for grade 2 lumbar spondylolisthesis? A Spine CORe™ analysis of QOD data.

Abstract

The objective of this study was to evaluate predictors of patient satisfaction following surgical treatment of Meyerding grade 2 lumbar spondylolisthesis. The authors hypothesized that postoperative improvements in patient-reported outcomes (PROs) would be the primary determinants of satisfaction. Patients with grade 2 lumbar spondylolisthesis were identified from the Spine CORe™ study group of the Quality Outcomes Database, a multicenter consortium of 14 participating sites. This cohort comprises 328 patients with a 60-month follow-up rate of 81%. Demographic, clinical, and surgical characteristics were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back (NRS-BP) and leg pain (NRS-LP), and EQ-5D, measured at baseline and at 60 months. The primary outcome was satisfaction at 60 months, assessed using the North American Spine Society patient satisfaction index. Satisfaction was defined as a score of 1 ("surgery met my expectations") or 2 ("I did not improve as much as I had hoped, but I would undergo the same surgery again"). Minimal clinically important difference (MCID) thresholds were ≥ 14.3 for the ODI, ≥ 0.2 for the EQ-5D, ≥ 1.7 for the NRS-LP, and ≥ 1.6 for the NRS-BP. Univariate comparisons and logistic regression were performed to identify predictors of satisfaction. A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At 5 years, follow-up data was complete in 266 patients (81%). Of these patients, 25 died within 5 years of surgery of unrelated causes and 241 had complete satisfaction scores at 5 years. At 60 months, 208 of the 241 patients were satisfied with surgery. Baseline demographic, comorbidity, and operative characteristics were similar between groups. Lower rates of 90-day readmissions were observed in satisfied patients (1.6% vs 19.4% p < 0.001). At 60 months, satisfied patients reported lower mean NRS-BP (2.6 vs 5.3, p < 0.001), NRS-LP (2.3 vs 5.2, p < 0.001), and ODI scores (8.9 vs 19.5, p < 0.001). MCID achievement was higher in satisfied patients for NRS-BP (78.3% vs 54.5%, p = 0.008), NRS-LP (79.8% vs 54.5%, p = 0.003), ODI (53.4% vs 15.2%, p < 0.001), and EQ-5D (30.0% vs 3.0%, p < 0.001) scores. In multivariable analysis, greater 5-year improvements in ODI (OR 0.88, p = 0.010) and NRS-LP (OR 0.74, p = 0.010) scores, as well as lower baseline NRS-LP scores (OR 0.54, p = 0.001) were independently associated with higher odds of satisfaction. No baseline demographic, comorbidity, or surgical factor predicted satisfaction. Eighty-six percent of patients with grade 2 lumbar spondylolisthesis were satisfied with results 5 years after surgery. Satisfaction was primarily associated with improvements in disability (ODI), while baseline and perioperative characteristics were not predictive.