Introduction: Success of spine surgery is increasingly being evaluated based on patient reported quality of life (QOL) outcomes. As more spine surgeries are being performed annually, there is increased scrutiny of patient selection and effectiveness of surgery. The objective of this study was to create a tool that accurately predicts QOL improvement greater than the minimum clinically important difference (MCID) following lumbar spine surgery.
Methods: A retrospective review of the electronic medical records was performed to identify all adult patients that underwent lumbar spine surgery at the Cleveland Clinic from 2009-2011. Exclusion criteria including previous lumbar spine surgery, infection, cancer, and trauma. Demographic, operative, and QOL (Pain/Disability Questionnaire [PDQ] and Euro-Qol 5-dimensions [EQ5D]) data were collected for all patients.
Results: 3006 patients were included, with an average age of 58, BMI of 29.6, and Charleston co-morbidity index of 2.8. 53% of patients were white, 70% married, and 16% active smokers at time of surgery. 33% underwent a laminotomy, 26% a laminectomy, 7.5% ALIF, 19.4% posterolateral fusion, and 9% underwent a PLIF/TLIF. Significant predictors of clinically relevant EQ5D improvement 1 year after surgery, included worse preoperative PDQ (Odds Ratio [OR] 2.2, p<0.001), undergoing a fusion procedure versus a decompression procedure (OR 1.7-2.5, p=0.002), and not being on medications for diabetes (OR=1.8, p=0.037) or anxiolytics (OR=1.6, p=0.008) (Figure 1). The c-index for this model was 0.655
Conclusions: This study demonstrates that when considering patient demographics, operative approaches, and primary surgeon, there are no significant differences in 2-year reoperation rates at preoperative quality of life, one can be moderately successful in predicting patients likely to have EQ5D improvements 1 year following surgery. Using these methods to develop risk calculators and nomograms, that can be used at the bedside will help lead to improved patient selection for lumbar spine surgery.
Patient Care: By identifying ways to better select patients that will have successful spine surgery and will have improvements in quality of life, this will allow for optimization of health care resources, and will allow avoidance of potentially unnecessary surgery
Learning Objectives: - To understand the importance of prediction tools in patient selection for spine surgery
- To understand the use of prospectively collected validated patient reported QOL questionnaires
- Identify the baseline characteristics associated with successful QOL outcome after lumbar spine surgery