Meeting Patient Expectations and Achieving a Minimal Clinically Important Difference for Back Disability, Back Pain, and Leg Pain May Provide Predictive Utility for Achieving Patient Satisfaction Among Lumbar Decompression Patients

Jacob, Kevin C.; Patel, Madhav R.; Collins, Andrew P.; Park, Grant; Vanjani, Nisheka N.; Prabhu, Michael C.; Pawlowski, Hanna; Parsons, Alexander W.; Singh, Kern

doi:10.1016/j.wneu.2022.03.002

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…In the present study, we found a significant reduction in the LOS in the ERAS frail group, though there was no significant difference in complications. Based on clinical experience, postoperative wound pain is correlated with patient satisfaction ( 23 ). Hence, a multimodal analgesia regimen as a part of an ERAS protocol should help maintain pain in the tolerable range.…”

Section: Discussionmentioning

confidence: 99%

“…Further analysis suggested that a higher baseline leg pain score predicted achieving the MCID in both cohorts. Jacob et al ( 23 ) conducted a retrospective study suggesting that meeting an MCID for the back and leg pain was associated with patient satisfaction in lumbar decompression patients. Our study showed a significant improvement in the ODI and VAS after the performance of the procedures both in the ERAS frail group and in the non-ERAS frail group.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Cui

Wang²,

Wang³

et al. 2022

Front. Surg.

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BackgroundEnhanced recovery after surgery (ERAS) is an evidence-based multimodal perioperative management designed to reduce the length of stay (LOS) and complications. The purpose of the present study is to evaluate the recovery of physiological function, LOS, complications, pain score, and clinical efficacy in frail elderly patients undergoing multisegment fusion surgery after the implementation of the ERAS protocol.MethodsFrail patients older than 75 years undergoing multilevel lumbar fusion surgery for degenerative discogenic conditions, lumbar spinal stenosis, and lumbar spondylolisthesis from January 2017 to December 2018 (non-ERAS frail group) and from January 2020 to December 2021 (ERAS frail group) were enrolled in the present study. Propensity score matching for age, sex, body mass index, and smoking status was performed to keep comparable characteristics between the two groups. Further recovery of physiological function, LOS, complications, pain score, and clinical efficacy were compared between the groups.ResultsThere were 64 pairs of well-balanced patients, and the clinical baseline data were comparable between the two groups. There was significant improvement in terms of recovery of physiological function (10.65 ± 3.51 days vs. 8.31 ± 3.98 days, p = 0.011) and LOS (12.18 ± 4.69 days vs. 10.44 ± 4.60 days, p = 0.035), while no statistical discrepancy was observed with regard to complications between the groups, which indicated favorable outcomes after the implementation of the ERAS protocol. Further analysis indicated that more patients were meeting a minimally clinical important difference for the visual analog score for the legs and the Oswestry Disability Index in the ERAS frail group. With regard to postoperative pain, the score was higher in the ERAS frail group than in the non-ERAS frail group on postoperative day (POD) 1 (4.88 ± 1.90 in the ERAS frail group vs. 4.27 ± 1.42 in the non-ERAS frail group, p = 0.042), while there was no significant discrepancy on POD 2 (3.77 ± 0.88 in the ERAS frail group vs. 3.64 ± 1.07 in the non-ERAS frail group, p = 0.470) and POD 3 (3.83 ± 1.89 in the ERAS frail group vs. 3.47 ± 1.75 in the non-ERAS frail group, p = 0.266).ConclusionsIn this retrospective cohort study, we found a significant improvement in terms of LOS, recovery of physiological function, and clinical efficacy after the implementation of the ERAS protocol in elderly and frail patients undergoing multilevel lumbar fusion surgery, while there was no significant discrepancy with regard to complications, 90-day readmission, and postoperative pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Cui

Wang²,

Wang³

et al. 2022

Front. Surg.

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“…A VAS score of 1.2 was applied as the minimum clinically important difference (MCID) in spine surgery patients with back pain as previously reported. 21,22 An ODI score of 8.2 was applied as the MCID in spine surgery patients with back pain as previously reported. 22 Secondary outcomes of cement leakage (n of events), refracture (n of events), and operation time (min) were also extracted.…”

Section: Data Extraction and Minimal Clinical Important Difference (M...mentioning

confidence: 99%

“…21,22 An ODI score of 8.2 was applied as the MCID in spine surgery patients with back pain as previously reported. 22 Secondary outcomes of cement leakage (n of events), refracture (n of events), and operation time (min) were also extracted. Refracture was considered any fracture reported post vertebral augmentation for the purpose of this meta-analysis.…”

Section: Data Extraction and Minimal Clinical Important Difference (M...mentioning

confidence: 99%

“…[25][26][27]29,30 Of the four included two-arm studies, zero reported cement leakage, two reported refracture, 11,23 and zero | 2707 reported operation time. Combining exercise groups from all studies, cement leakage events occurred at a rate of 0.13 (95% CI: 0.06, 0.20, I 2 = 71.06%), 22,27,[29][30][31] refracture incidences were 0.08 (95% CI: 0.03, 0.11, I 2 = 56.99%), 11,23,25,26,30,31 and operation time was 40.05 min (95% CI: 29.94, 50.15, I 2 = 99.12%) [25][26][27]29,30 (Table 4). As there were no reports of cement leakage in the two-arm studies, exercise effect cannot be determined on those outcomes.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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The effect of exercise post vertebral augmentation in osteoporotic patients: A systematic review and meta‐analysis

Than

Adra

Curtis

et al. 2023

Journal Orthopaedic Research

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This meta‐analysis investigated the effects of exercise on Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores following vertebroplasty or kyphoplasty in osteoporotic fractures. A literature search of PubMed, EMBASE (Elsevier), CiNAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 6, 2022. Eligible studies reported osteoporosis patients over 18 years of age with a diagnosis of at least one vertebral fracture via radiography or clinical assessment. This review was registered in PROSPERO (ID: CRD42022340791). Ten studies met the eligibility criteria (n = 889). VAS scores at baseline were 7.75 (95% CI: 7.54, 7.97, I2 = 76.11%). Following initiation of exercise, VAS scores at the endpoint of 12 months were 1.91 (95% CI: 1.53, 2.29, I2 = 92.69%). ODI scores at baseline were 68.66 (95% CI: 56.19, 81.13, I2 = 85%). Following initiation of exercise, ODI scores at the endpoint of 12 months were 21.20 (95% CI: 14.52, 27.87, I2 = 99.30). A two‐arm analysis demonstrated improved VAS and ODI for the exercise group compared to non‐exercise control at 6 months (MD = −0.70, 95% CI: −1.08, −0.32, I2 = 87% and MD = −6.48, 95% CI: −7.52, −5.44, I2 = 46%, respectively) and 12 months (MD = −0.88, 95% CI: −1.27, −0.49, I2 = 85% and MD = −9.62, 95% CI: −13.24, −5.99, I2 = 93%). Refracture was the only adverse event reported and occurred almost twice as frequently in the non‐exercise group than in the exercise group. Exercise rehabilitation post vertebral augmentation is associated with improved pain and functionality, particularly after 6 months of exposure, and may reduce refracture rate.

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Patient satisfaction with cluneal nerve entrapment surgery

Kim

Kokubo²,

Isu³

et al. 2022

Acta Neurochir

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Meeting Patient Expectations and Achieving a Minimal Clinically Important Difference for Back Disability, Back Pain, and Leg Pain May Provide Predictive Utility for Achieving Patient Satisfaction Among Lumbar Decompression Patients

Cited by 5 publications

References 31 publications

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol

The effect of exercise post vertebral augmentation in osteoporotic patients: A systematic review and meta‐analysis

Patient satisfaction with cluneal nerve entrapment surgery

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