Spine Center Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland.
Eur Spine J. 2012 Aug;21(8):1625-32. doi: 10.1007/s00586-012-2261-8. Epub 2012 Apr 6.
The last few decades have witnessed a paradigm shift in the assessment of outcome in spine surgery, with patient-centred questionnaires superseding traditional surgeon-based assessments. The assessment of complications after surgery and their impact on the patient has not enjoyed this same enlightened approach. This study sought to quantify the incidence and bothersomeness of patient-rated complications 1 year after surgery.
Patients with lumbar degenerative disorders, operated with the goal of pain relief between October 2006 and September 2010, completed a questionnaire 1 year postoperatively enquiring about complications arising as a consequence of their operation. They rated the bothersomeness of any such complications on a 5-point scale. Global outcome of surgery and satisfaction at the 12-month follow-up were also rated on 5-point Likert scales. The multidimensional Core Outcome Measures Index (COMI) was completed preoperatively and at the 12-month follow-up.
Of 2,282 patients completing the questionnaire (92% completion rate), 687 (30.1%) reported complications, most commonly sensory disturbances (36% of those with complications) or ongoing/new pain (26%), followed by motor problems (8%), pain plus neurological disturbances (11%), and problems with wound healing (6%). The corresponding "bothersomeness" ratings for these were: 1% not at all, 23% slightly, 27% moderately, 31% very, and 18% extremely bothersome. The greater the bothersomeness, the worse the global outcome (Rho = 0.51, p < 0.0001), patient satisfaction (Rho = 0.44, p < 0.0001) and change in COMI score (Rho = 0.52, p < 0.0001).
Most complications reported by the patient are perceived to be at least moderately bothersome and hence are not inconsequential. Complications and their severity should be assessed from both the patient's and the surgeon's perspectives--not least to better understand the reasons for poor outcome and dissatisfaction with treatment.
在过去几十年中，脊柱外科手术结果的评估发生了范式转变，以患者为中心的问卷取代了传统的基于医生的评估。然而，手术后并发症的评估及其对患者的影响并没有采用这种明智的方法。本研究旨在量化患者在手术后 1 年时报告的并发症的发生率和困扰程度。
2006 年 10 月至 2010 年 9 月期间，患有腰椎退行性疾病的患者接受了旨在缓解疼痛的手术，他们在术后 1 年完成了一份调查问卷，询问与手术相关的并发症。他们对任何此类并发症的困扰程度进行了 5 分制评分。手术的总体结果和 12 个月随访时的满意度也进行了 5 分制 Likert 评分。术前和 12 个月随访时完成多维核心结局测量指标（COMI）。
在完成问卷的 2282 名患者中（完成率为 92%），687 名（30.1%）报告了并发症，最常见的是感觉障碍（有并发症的患者中占 36%）或持续/新出现的疼痛（26%），其次是运动问题（8%）、疼痛加神经功能障碍（11%）和伤口愈合问题（6%）。这些并发症的相应“困扰”评分分别为：1%一点也不，23%轻微，27%中度，31%非常，18%极度困扰。困扰程度越高，总体结果越差（Rho = 0.51，p < 0.0001），患者满意度越低（Rho = 0.44，p < 0.0001），COMI 评分变化越大（Rho = 0.52，p < 0.0001）。
患者报告的大多数并发症至少被认为是中度困扰，因此并非无关紧要。应从患者和医生的角度评估并发症及其严重程度——这不仅有助于更好地理解治疗效果不佳和对治疗不满意的原因。
