Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO, USA.
Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO, USA.
Spine J. 2023 Aug;23(8):1115-1126. doi: 10.1016/j.spinee.2023.04.018. Epub 2023 May 5.
Adult spinal deformity (ASD) surgery can improve patient pain and physical function but is associated with high complication rates and long postoperative recovery. Accordingly, if given a choice, patients may indicate they would not undergo ASD surgery again.
Evaluate surgically treated ASD patients to assess if given the option (1) would surgically treated ASD patients choose to undergo the same ASD surgery again, (2) would the treating surgeon perform the same ASD surgery again and if not why, (3) evaluate for consensus and/or discrepancies between patient and surgeon opinions for willingness to perform/receive the same surgery, and (4) evaluate for associations with willingness to undergo or not undergo the same surgery again and patient demographics, patient reported outcomes, and postoperative complications.
Retrospective review of a prospective ASD study.
Surgically treated ASD patients enrolled into a multicenter prospective study.
Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36) physical component summary (PCS) and mental component summary (MCS), Oswestry Disability Index (ODI), numeric pain rating for back pain (NRS back) and leg pain (NRS leg), minimal clinically important difference (MCID) for SRS-22r domains and ODI, intraoperative and postoperative complications, surgeon and patient satisfaction with surgery.
Surgically treated ASD patients prospectively enrolled into a multicenter study were asked at minimum 2-year postoperative, if, based upon their hospital and surgical experiences and surgical recovery experiences, would the patient undergo the same surgery again. Treating surgeons were then matched to their corresponding patients, blinded to the patients' preoperative and postoperative patient reported outcome measures, and interviewed and asked if (1) the surgeon believed that the corresponding patient would undergo the surgery again, (2) if the surgeon believed the corresponding patient was improved by the surgery and (3) if the surgeon would perform the same surgery on the corresponding patient again, and if not why. ASD patients were divided into those indicating they would (YES), would not (NO) or were unsure (UNSURE) if they would have same surgery again. Agreement between patient and surgeon willingness to receive/perform the same surgery was assessed and correlations between patient willingness for same surgery, postoperative complications, spine deformity correction, patient reported outcomes (PROs).
A total of 580 of 961 ASD patients eligible for study were evaluated. YES (n=472) had similar surgical procedures performed, similar duration of hospital and ICU stay, similar spine deformity correction and similar postoperative spinal alignment as NO (n=29; p>.05). UNSURE (n=79) had greater preoperative depression and opioid use rates, UNSURE and NO had more postoperative complications requiring surgery, and UNSURE and NO had fewer percentages of patients reaching postoperative MCID for SRS-22r domains and MCID for ODI than YES (p<.05). Comparison of patient willingness to receive the same surgery versus surgeon perceptions on patient's willingness to receive the same surgery demonstrated surgeons accurately identified YES (91.1%) but poorly identified NO (13.8%; p<.05).
If given a choice, 18.6% of surgically treated ASD patients indicated they were unsure or would not undergo the surgery again. ASD patients indicating they were unsure or would not undergo ASD surgery again had greater preoperative depression, greater preoperative opioid use, worse postoperative PROs, fewer patients reaching MCID, more complications requiring surgery, and greater postoperative opioid use. Additionally, patients that indicated they would not have the same surgery again were poorly identified by their treating surgeons compared to patients indicating they would be willing to receive the same surgery again. More research is needed to understand patient expectations and improve patient experiences following ASD surgery.
成人脊柱畸形（ASD）手术可以改善患者的疼痛和身体功能，但与高并发症发生率和术后恢复时间长有关。因此，如果有选择，患者可能会表示他们不会再次接受 ASD 手术。
评估接受手术治疗的 ASD 患者，以评估（1）如果有选择，接受手术治疗的 ASD 患者是否会再次选择接受相同的 ASD 手术，（2）治疗医生是否会再次进行相同的 ASD 手术，如果不会，原因是什么，（3）评估患者和医生对接受/进行相同手术的意愿是否存在共识和/或差异，以及（4）评估与再次接受或不接受相同手术的意愿以及患者人口统计学、患者报告的结果和术后并发症相关的因素。
前瞻性 ASD 研究的回顾性研究。
纳入多中心前瞻性研究的接受手术治疗的 ASD 患者。
共有 961 例 ASD 患者中符合条件的 580 例患者接受了评估。YES（n=472）组接受了相似的手术，住院和 ICU 时间相似，脊柱畸形矫正相似，术后脊柱排列相似，而 NO（n=29）组差异无统计学意义（p>.05）。UNSURE（n=79）组术前抑郁和阿片类药物使用比例较高，UNSURE 和 NO 组术后并发症需要手术的比例较高，UNSURE 和 NO 组达到 SRS-22r 域和 ODI 术后 MCID 的患者比例较低（p<.05）。患者对接受相同手术的意愿与医生对患者接受相同手术意愿的评估相比，医生准确地识别出了 YES（91.1%）患者，但对 NO（13.8%）患者的识别较差（p<.05）。
如果有选择，18.6%的接受手术治疗的 ASD 患者表示他们不确定或不会再次接受手术。表示不确定或不会再次接受 ASD 手术的 ASD 患者术前抑郁程度较高，术前阿片类药物使用较多，术后 PROs 较差，达到 MCID 的患者较少，需要手术的并发症较多，术后阿片类药物使用较多。此外，与表示愿意接受相同手术的患者相比，治疗医生对表示不会接受相同手术的患者的识别较差。需要进一步研究以了解患者的期望并改善 ASD 手术后的患者体验。
