Chapin Laura, Ward Kelly, Ryken Timothy
*Department of Neurosurgery, Iowa Spine and Brain Institute, Waterloo †Department of Neurosurgery, University of Iowa, Iowa City, IA.
Clin Spine Surg. 2017 Jul;30(6):E725-E732. doi: 10.1097/BSD.0000000000000331.
Prospective cohort study.
To determine whether comorbidities and demographics, identified preoperatively, can impact patient outcomes and satisfaction after lumbar spine surgery.
The surgical treatment of lower back pain does not always eliminate a patient's pain and symptoms. Revision surgeries are costly and expose the patient to additional risk. We aim to identify patient characteristics that may suggest a greater or lesser likelihood of postsurgical success by examining patient-reported measures and outcomes after surgery.
Preoperative smoking status, self-reported depression, prevalence of diabetes, obesity, level of education, and employment status were assessed in the context of patient outcome and satisfaction after lumbar spine surgery. Patients were contacted before surgery, and at 3 and 12 months postoperatively, and responded to Oswestry Disability Index (ODI) and EuroQol-5 Dimensions (EQ-5D) self-assessment examinations, as well as a satisfaction measure.
A total of 166 patients who underwent lumbar spine surgeries at Iowa Spine and Brain Institute, a department of Covenant Medical Center, and were included in the National Neurosurgery Quality and Outcomes Database were assessed preoperatively, and at 3 and 12 months postoperatively using self-assessment tools. Depression, smoking, and employment status were found to be significant factors in patient satisfaction. Depressed patients, smokers, and patients on disability at the time of surgery have worse ODI and EQ-5D scores at all of the timepoints (baseline, 3 months, and 12 months postsurgery).
Depression, smoking, and employment status, specifically whether a patient is on disability at the time of surgery, are all significant factors in patient satisfaction after lumbar spine surgery. These factors are also shown in impact ODI and EQ-5D scores. Surgeons should consider these particular characteristics when developing a lower back pain treatment plan involving surgery.
前瞻性队列研究。
确定术前识别出的合并症和人口统计学因素是否会影响腰椎手术后的患者结局和满意度。
下背痛的手术治疗并不总能消除患者的疼痛和症状。翻修手术成本高昂，且会使患者面临额外风险。我们旨在通过检查患者报告的术后措施和结局，确定可能提示手术成功可能性大小的患者特征。
在腰椎手术后的患者结局和满意度背景下，评估术前吸烟状况、自我报告的抑郁情况、糖尿病患病率、肥胖情况、教育程度和就业状况。在手术前、术后3个月和12个月与患者联系，患者对奥斯威斯利残疾指数（ODI）和欧洲五维健康量表（EQ - 5D）自我评估检查以及一项满意度测量进行回应。
共有166例在圣约医疗中心的爱荷华脊柱与脑研究所接受腰椎手术并被纳入国家神经外科质量与结局数据库的患者，在术前以及术后3个月和12个月使用自我评估工具进行了评估。发现抑郁、吸烟和就业状况是影响患者满意度的重要因素。抑郁患者、吸烟者以及手术时处于残疾状态的患者在所有时间点（基线、术后3个月和12个月）的ODI和EQ - 5D评分都更差。
抑郁、吸烟和就业状况，特别是患者在手术时是否处于残疾状态，都是腰椎手术后患者满意度的重要因素。这些因素也显示出会影响ODI和EQ - 5D评分。外科医生在制定涉及手术的下背痛治疗方案时应考虑这些特定特征。
