Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis

Paulsen, Rune Tendal; Bouknaitir, Jamal Bech; Fruensgaard, Søren; Carreon, Leah Y.; Andersen, Mikkel

doi:10.1093/neuros/nyx298

Cited by 40 publications

(45 citation statements)

References 31 publications

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“…10,11 In agreement with our results, both studies showed an association between significant improvements in HRQOL and satisfaction with treatment outcomes. 10,11 In addition, Hamilton et al 10 also showed no relation between the occurrence of adverse events (major or minor) and satisfaction. The high rates of satisfaction in both cohorts are in line with results after other palliative cancer treatments despite high morbidity rates and poor overall survival.…”

Section: Discussionsupporting

confidence: 92%

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

Versteeg

Sahgal

Kawahara

et al. 2019

Cancer

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BackgroundPatient satisfaction is infrequently investigated despite its importance in assessing efficacy and patient comprehension. The purpose of this study was to investigate patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases and to evaluate how health‐related quality of life (HRQOL) is related to patient satisfaction.MethodsPatients with spinal metastases treated with surgery and/or radiotherapy were enrolled in a prospective, international, observational study. Demographic, histologic, treatment, and HRQOL data were collected. HRQOL was evaluated with the Numeric Rating Scale pain score, the 3‐level version of the EuroQol 5‐Dimension (EQ‐5D‐3L) instrument, and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). Patient satisfaction was derived from the SOSGOQ2.0 at 6, 12, and 26 weeks after treatment. Patients were classified as satisfied, neutral, or dissatisfied.ResultsTwelve weeks after treatment, 183 of the surgically treated patients (84%) were satisfied, and only 11 (5%) were dissatisfied; in contrast, 101 of the patients treated with radiotherapy alone (77%) were satisfied, and only 7 (5%) were dissatisfied. Significant improvements in pain, physical function, mental health, social function, leg function, and EQ‐5D were associated with satisfaction after surgery. Satisfaction after radiotherapy was associated with significant improvements in pain, mental health, and overall SOSGOQ2.0 scores. Dissatisfaction after treatment was associated with lower baseline values for leg strength and lower social functioning scores for surgically treated patients and with lower social functioning scores and being single for patients treated with radiotherapy.ConclusionsHigh levels of satisfaction with treatment outcomes are observed after surgery and/or radiotherapy for spinal metastases. Posttreatment satisfaction is associated with significant improvements in pain and different dimensions of HRQOL.

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Section: Discussionsupporting

confidence: 92%

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

Versteeg

Sahgal

Kawahara

et al. 2019

Cancer

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“…The majority of the original studies included in the systematic review were of “low quality” and based on small patient samples, likely leading to overly simplified prediction models based on a single or a few prognostic indicators. More recently, several studies identified that a higher degree of baseline disability is associated with increased improvement of functional outcome [ 20 , 36 – 38 ], while smoking [ 36 , 39 , 40 ] and psychiatric disease [ 20 , 41 ] were associated with an unfavorable outcome. Athiviraham et al[ 20 ] reported that higher BMI was associated with less functional improvement, while Pearson et al [ 36 ] reported no difference in function between patients with BMI greater than or equal to 30 and those with a BMI below 30.…”

Section: Discussionmentioning

confidence: 99%

Prognostic function to estimate the probability of meaningful clinical improvement after surgery - Results of a prospective multicenter observational cohort study on patients with lumbar spinal stenosis

et al. 2018

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BackgroundApproximately two thirds of patients with lumbar spinal stenosis (LSS) who undergo surgical treatment benefit from the surgery. The objective of this study was to derive a prognostic probability function (PPF) to identify patients with a high probability of post-surgical improvement because there is currently no method available.MethodsIn this multicenter, prospective, observational study, we collected data from eight medical centers in Switzerland in which patients underwent surgery for LSS. The endpoints were meaningful clinically important differences (MCID) in pain and disability one year after baseline. We developed a PPF named PROCESS (PostopeRative OutComE Spinal Stenosis), based on a large set of prognostic indicators extracted from the literature. The PPF was derived using data from a random subset of two thirds of the patients and validated in the remaining third. We addressed overfitting by shrinking the regression coefficients. The area under the ROC curve (AUC) and calibration determined the accuracy of the PPF.ResultsIn this study, 452 LSS patients received surgery. 73% of the 300 patients in the derivation subset reached an MCID in pain and 68% reached an MCID in disability. The corresponding values were 70% and 63% in the validation subset, respectively. In the derivation subsample, the AUC was 0.64 (95% CI 0.57 to 0.71) for of the PPF predicting MCID in pain and 0.71 (0.64 to 0.77) for MCID in disability, after shrinkage. The corresponding numbers were 0.62 (0.52 to 0.72) and 0.70 (0.60 to 0.79) in the validation subsample, and the PPF showed good calibration.ConclusionsSurgical treatment for patients with lumbar spinal stenosis is being performed with increasing frequency. PROCESS is conditional on the individual pattern of preoperatively available prognostic indicators, and may be helpful for clinicians in counselling patients and in guiding the discussion on individual treatment decision in the era of personalized medicine.

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“…comes of conservatively and surgically managed patients with lumbar spinal stenosis have been reported at 4 to 5 years postoperatively. 13,20,28 A recent trend has been to use prospectively collected clinical registries to evaluate the quality of lumbar spinal stenosis care and to optimize healthcare resource distribution. 4,8 A key field of investigation involves identification of preoperative factors and/or patient characteristics that may affect patient-reported outcomes after surgical intervention for lumbar spinal stenosis.…”

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confidence: 99%

Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis

Elsayed

Erwood

Davis

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEThis study defines the association of preoperative physical activity level with functional outcomes at 3 and 12 months following surgical decompression for lumbar spinal stenosis.METHODSData were collected as a prospective observational registry at a single institution from 2012 through 2015, and then analyzed with a retrospective cohort design. Patients who were able to participate in activities outside the home preoperatively were compared to patients who did not participate in such activities, with respect to 3-month and 12-month functional outcomes postintervention, adjusted for relevant confounders.RESULTSNinety-nine patients were included. At baseline, sedentary/inactive patients (n = 55) reported greater back pain, lower quality of life, and higher disability than similarly treated patients who were active preoperatively. Both cohorts experienced significant improvement from baseline in back pain, leg pain, disability, and quality of life at both 3 and 12 months after lumbar decompression surgery. At 3 months postintervention, sedentary/inactive patients reported more leg pain and worse disability than patients who performed activities outside the home preoperatively. However, at 12 months postintervention, there were no statistically significant differences between the two cohorts in back pain, leg pain, quality of life, or disability. Multivariate analysis revealed that sedentary/inactive patients had improved disability and higher quality of life after surgery compared to baseline. Active patients experienced greater overall improvement in disability compared to inactive patients.CONCLUSIONSSedentary/inactive patients have a more protracted recovery after lumbar decompression surgery for spinal stenosis, but at 12 months postintervention can expect to reach similar long-term outcomes as patients who are active/perform activities outside the home preoperatively.

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Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis

Abstract: This study found smoking, long duration of leg pain, and cancerous and neurological disease to be associated with patient dissatisfaction, whereas good walking capacity at baseline was positively associated with satisfaction after 1 yr.

Cited by 40 publications

References 31 publications

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

Prognostic function to estimate the probability of meaningful clinical improvement after surgery - Results of a prospective multicenter observational cohort study on patients with lumbar spinal stenosis

Association between preoperative activity level and functional outcome at 12 months following surgical decompression for lumbar spinal stenosis

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