Introduction: There is a paucity of data examining patient characteristics that affect improvement in quality of life following lumbar laminectomy and fusion.
Methods: 332 patients undergoing lumbar laminectomy and fusion in 3 or fewer levels were included in this study. Patient demographics, perioperative data, and 90-day postoperative complications were gathered from the medical record. Preoperative, 3-month, and 12-month EQ-5D, ODI, NRS-back pain, NRS-leg pain, ZUNG depression rating, and MSPQ anxiety rating were collected prospectively via our spinal outcomes registry. Multivariate linear regression analysis was performed to assess the association between EQ-5D change scores at 3-months and 1-year with age, gender, BMI, ASA grade, blood loss, primary vs. revision surgery, use of an interbody fusion, history of smoking, history of diabetes, 90-day complications, preoperative ZUNG depression rating, preoperative MSPQ anxiety rating, preoperative NRS-back/leg pain, and preoperative ODI as covariates.
Results: Univariate analysis revealed significant improvement at 3 and 12-month follow-up for EQ-5D, ODI, NRS-back pain, and NRS-leg pain (p<0.001). Multivariate analysis at 3-months demonstrated that increased age (p<0.001), increased preoperative NRS-back pain (p = 0.001), and worse preoperative ODI (p=0.001) resulted in greater improvement in EQ-5D, whereas increased anxiety (MSPQ, p=0.015) resulted in less improvement in EQ-5D. Multivariate analysis at 1-year demonstrated that increased age (p = 0.012) and worse preoperative ODI (p<0.001) resulted in greater improvement in EQ-5D, whereas increased anxiety (MSPQ, p<0.001) and 90-day complications (p=0.006) resulted in less improvement in EQ-5D at 1 year.
Conclusions: Significant improvement occurs in all outcomes measures at 3-months and 1-year following lumbar laminectomy and fusion. Additionally, it appears that older patients and those with higher levels of back specific disability (ODI) have greater gains in quality of life at both 3-months and 1-year after surgery. Patients with higher anxiety preoperatively appear to have decreased improvement in quality of life at both 3-months and 1-year postoperatively.
Patient Care: This research will improve patient care by helping surgeons select patients with the preoperative characteristics that can lead to maximal improvement in quality of life.
Learning Objectives: The abstract examines preoperative characteristics that are significantly associated with patient improvement in quality of life (EQ-5D). Through this study, we learn that preoperative back disability (ODI), back pain (NRS-Back), anxiety (MSPQ), age, and complications all have an effect on a patients quality of life in the short-term (3-months), long-term (1-year), or both.