Introduction: Patients with a high number of reported drug allergies are often labeled as histrionic individuals with the perception they will have worse outcomes following spine surgery. This study evaluates the effect of reported drug allergies on PROs and satisfaction following surgery for degenerative lumbar spine disease.

Methods: Patients undergoing surgery for degenerative lumbar spine disease were enrolled into a prospective registry over 2 years. 998 patients were included in analysis. Baseline and 12-month PRO values were prospectively recorded: ODI%, SF-12, VAS-BP, and VAS-LP. Patients with ZDS>33 were characterized as depressed, and patients with MSPQ>12 as anxious. Number of drug allergies was collected and categorized into 4 groups: 0, 1-2, 3-5, and >5. Mean absolute and change-score between groups were compared using ANOVA. Chi-square test was used to compare achievement of MCID and satisfaction. Binary logistic regression was used to determine the effect of reported drug allergies on achieving MCID for ODI%.

Results: Mean 12-month absolute scores were significantly worse with increasing number of allergies (Allergy group 4 > 3 > 2 > 1) for the following outcome measures: ODI% (P<0.001), SF-12 PCS (P<0.001), VAS-BP (P=0.018), VAS-LP (P=0.013). No difference in 12-month change scores was observed for all PROs. No difference in proportion of patients achieving MCID or satisfaction was observed for all PROs. Binary logistic regression demonstrated no association between number of allergies and achievement of MCID (ODI%). Number of allergies was significantly greater in patients with depression (P=0.042) and anxiety (P=0.036).

Conclusions: Patients with >5 reported drug allergies have worse absolute pain and disability one year following lumbar spine surgery. However, 12-month change scores, achievement of MCID for PROs, and satisfaction are not dependent on number of reported drug allergies. Screening for patients with a high number of reported allergies for depression and anxiety may help select patients for perioperative psychological care.

Patient Care: Because of the association between a high number of drug allergies and psychiatric conditions like depression and anxiety, the ability for surgeons to screen for these patients may help select patients for preoperative psychiatric care. This can in itself improve patient outcomes and address non-surgical issues that affect the patient.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the effect of reported drug allergies on patient-reported outcomes. 2) Describe the relationship between reported reported drug allergies and psychiatric comorbidities. 3) Understand that reported drug allergies may help as a screening tool for depression and anxiety.

References: 1. Tamayo E, Alvarez FJ, Castrodeza J, Yánez J, Arnaiz P, Lajo C, Soria S. Self-reported drug allergies and the diagnostic work-up in the surgical population. J Eval Clin Pract. 2010 Oct;16(5):902-4. 2. Bell IR, Schwartz GE, Peterson JM, Amend D. Symptom and personality profiles of young adults from a college student population with self-reported illness from foods and chemicals. J Am Coll Nutr. 1993 Dec;12(6):693-702.