Introduction: Osteoarthritis has been shown to affect postoperative outcomes after surgery. However, there is a paucity of data assessing the influence osteoarthritis has on perception of pain before and after complex spinal surgery. The aim of this study was to determine whether osteoarthritis impacts patient-reported pain scores and ambulation after elective complex spinal fusion (=5 levels) for deformity correction.
Methods: The medical records of 98 adult (=18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (=5 level) for deformity correction a major academic institution from 2005 to 2015 were reviewed. We identified 35(35.7%) patients with a clinical diagnosis of osteoarthritis and 63(64.3%) patients without (OA: n=35; No-OA: n=63). Patient demographics, comorbidities, intra- and post-operative complication rates, baseline and post-operative patient-reported pain scores, ambulatory status, and narcotic refills were collected for each patient. The primary outcome was the post-operative patient reported pain scores.
Results: Patient demographics and comorbidities were similar between both cohorts, with OA-cohort having a greater mean age (67.8 years vs. 48.6 years, p<0.0001). The median number of fusion levels operated, length of surgery, estimated blood loss, and complication rate were similar between both cohorts. Moreover, the post-operative complication profiles between the cohorts were also similar. There were no significant differences between both cohorts in baseline pain score (OA: 5.7±2.6 vs. Non-OA: 5.4±3.4, p=0.571), first post-operative pain score (OA: 6.5±2.9 vs. Non-OA: 5.9±2.8, p=0.345), and last pain score prior to discharge (OA: 4.8±3.5vs. Non-OA: 3.6±3.1, p=0.114). Similarly, there were no significant differences in number of days for OR to ambulation (p=0.0842), number of first ambulatory steps (p=0.137) and last ambulatory steps (p=0.327).
Conclusions: Our study suggests that osteoarthritis does not significantly affect surgical outcome, patient reported pain scores, and post-operative ambulatory status after complex spinal surgery requiring =5 levels of fusion. Further studies are necessary to corroborate our findings.
Patient Care: Our research identifies a patient comorbidity that may impact patient reported outcomes and perception of pain after complex spinal deformity.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of osteoarthritis on surgical outcomes, 2) Discuss, in small groups, the impact that osteoarthritis can have on perception of pain, 3) Identify an effective interventions that can accurately describe the post-operative pain after spine surgery in patients with osteoarthritis.