Introduction: Compiling a list of allergies is an important part of the medical history. Patients who self-report allergies have a higher prevalence of Axis I disorders such as anxiety and somatization. Previous studies have found that patient-reported allergies correlate with poorer outcomes after hip and knee arthroplasty. We hypothesized that patient-reported allergies correlate with inferior postsurgical quality of life outcomes and cost of admission following cervical or lumbar spinal surgery.
Methods: A retrospective cohort study at a single tertiary-care institution.
Results: 640 cervical and 4,805 lumbar patients were included. Cervical and lumbar patients had an average age of 56.5 and 59.1 years and were admitted for a median of 1 and 3 days, respectively. For both cervical and lumbar patients, the most common type of allergy was to a medication (median of 1 reported allergy), while the median total reported allergies was 2. Cervical patients improved in the PDQ from an average of 79.9 to 58.4 following surgery (p<0.0001), while lumbar patients improved from an average of 80.8 to 58.7 (p<0.0001). After adjusting for covariates, the log-transformed number of allergies was associated with superior PDQ outcomes for both cervical (ß=-4.02, p=0.04) and lumbar (ß=-9.6) patients. The log-transformed number of allergies was associated with increased odds of improvements in the PDQ exceeding the MCID for both cervical (OR 1.34, p=0.02) and lumbar (OR 2.12, p=0.02) patients. No significant correlations were found between number of allergies and overall quality of life (EQ-5D) or mental health (PHQ-9) scores. Log-transformed number of allergies was associated with significantly increased cost of admission for both cervical (ß=$2,754, p<0.0001) and lumbar (ß=$3,369, p<0.01) patients.
Conclusions: Patients with higher numbers of recorded allergies are more likely to experience greater reductions in self-reported pain burden after spinal surgery. Higher numbers of allergies are associated with higher costs of care during admission.
Patient Care: Patient-reported allergies may serve as a marker of admission costs and postoperative outcomes after spinal surgery.
Learning Objectives: By the conclusion of this session, participants should be able to
1) Describe the effect of patient-reported allergies on clinical outcomes following spine surgery.
2) Discuss, in small groups, reasons why increased patient-reported allergies is associated with inferior quality of life and financial outcomes.
3) Identify that spine surgery as a treatment may not benefit all patients equally.