Introduction: Complications happen to all spine surgeons. Understanding their effect on long-term patient-reported outcomes(PROs) following lumbar surgery is vital. We evaluated effect of occurrence of 90-day complication on short and long-term PROs in patients undergoing elective spine surgery.
Methods: 906 consecutive patients undergoing elective surgery for degenerative lumbar disease were enrolled into prospective longitudinal registry. PROs were recorded at baseline, 3-months post-operatively, and 12-months post-operatively [ODI, NRS-back and leg pain(BP,LP), EQ-5D, and NASS satisfaction questionnaire]. Major complication defined as surgical site infection, hardware failure, neurological deficit, pulmonary embolism, hematoma, or MI. Univariate and multivariate linear regression analyses conducted to assess effect of complication on outcome.
Results: 108(12%) patients developed major complication within 90-days post-operatively. Patients with complication had significantly lower improvement in ODI(13.5%±21.2% vs. 21.7%±19.0%, p<0.0001), EQ-5D(0.17±0.25 vs. 0.23±0.23, p=0.04), SF-12 PCS(8.6±13.3 vs. 13.0±11.9, p<0.001) and satisfaction(76% vs. 90%, p=0.02) at 3-months post-operatively(Table 1). However, there was no statistically significant difference in change scores from baseline to 12 months for any PRO assessed in patients with and without major complications(Table 2). In multivariate linear regression analysis, occurrence of major complication was not associated with worse ODI score 12-months post-operatively(Table3). There was no difference in percentage of patients achieving MCID for ODI(64% vs. 66%), NRS-BP(56% vs. 55%), NRS-LP(59% vs. 62%), EQ-5D(14% vs. 19%), or patient satisfaction rates(80% vs. 82%) between those with and without major complications 12-months post-operatively(Table 2).
Conclusions: Major complications within 90-days following lumbar spine surgery had significant impact on short-term patient-reported outcomes; however, there was no effect on long-term outcomes(12-months post-operatively). These patients achieved clinically meaningful improvements in outcome and patient satisfaction to same extent as those without major complication by 12-months post-operatively. This information allows surgeons to council patients that, while a complication can certainly create frustration and inconvenience initially, it does not appear to adversely affect long-term outcomes or satisfaction.
Patient Care: This information allows surgeons to council patients that, while a complication can certainly create frustration and inconvenience initially, it does not appear to adversely affect long-term outcomes or satisfaction with surgery.
Learning Objectives: By the conclusion of this session, participants should be able to understand that:
1) 90-day complications were associated with worse short-term outcomes (3-months after surgery)
2) 90-day complications did not results in worse long-term outcomes or patient satisfaction with surgery (12-months after surgery)
3) Patients acutely experiencing a complication can be informed that their complication can be viewed as a “bump in the road”, but ultimately should not doom them to worse long-term outcomes.