PMID- 26621422 OWN - NLM STAT- MEDLINE DCOM- 20160913 LR - 20151201 IS - 1092-0684 (Electronic) IS - 1092-0684 (Linking) VI - 39 IP - 6 DP - 2015 Dec TI - Effect of complications within 90 days on patient-reported outcomes 3 months and 12 months following elective surgery for lumbar degenerative disease. PG - E8 LID - 10.3171/2015.8.FOCUS15302 [doi] AB - OBJECT There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency in large aggregate data sets. Understanding how complications affect long-term patient-reported outcomes (PROs) following degenerative lumbar surgery is vital. The authors hypothesized that 90-day complications would adversely affect long-term PROs. METHODS Nine hundred six consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of 4 years were enrolled into a prospective longitudinal registry. The following PROs were recorded at baseline and 12-month follow-up: Oswestry Disability Index (ODI) score, numeric rating scales for back and leg pain, quality of life (EQ-5D scores), general physical and mental health (SF-12 Physical Component Summary [PCS] and Mental Component Summary [MCS] scores) and responses to the North American Spine Society (NASS) satisfaction questionnaire. Previously published minimum clinically important difference (MCID) threshold were used to define meaningful improvement. Complications were divided into major (surgicalsite infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and myocardial infarction) and minor (urinary tract infection, pneumonia, and deep venous thrombosis). RESULTS Complications developed within 90 days of surgery in 13% (118) of the patients (major in 12% [108] and minor in 8% [68]). The mean improvement in ODI scores, EQ-5D scores, SF-12 PCS scores, and satisfaction at 3 months after surgery was significantly less in the patients with complications than in those who did not have major complications (ODI: 13.5 +/- 21.2 vs 21.7 +/- 19, < 0.0001; EQ-5D: 0.17 +/- 0.25 vs 0.23 +/- 0.23, p = 0.04; SF-12 PCS: 8.6 +/- 13.3 vs 13.0 +/- 11.9, 0.001; and satisfaction: 76% vs 90%, p = 0.002). At 12 months after surgery, the patients with major complications had higher ODI scores than those without complications (29.1 +/- 17.7 vs 25.3 +/- 18.3, p = 0.02). However, there was no difference in the change scores in ODI and absolute scores across all other PROs between the 2 groups. In multivariable linear regression analysis, after controlling for an array of preoperative variables, the occurrence of a major complication was not associated with worsening ODI scores 12 months after surgery. There was no difference in the percentage of patients achieving the MCID for disability (66% vs 64%), back pain (55% vs 56%), leg pain (62% vs 59%), or quality of life (19% vs 14%) or in patient satisfaction rates (82% vs 80%) between those without and with major complications. CONCLUSIONS Major complications within 90 days following lumbar spine surgery have significant impact on the short-term PROs. Patients with complications, however, do eventually achieve clinically meaningful outcomes and report satisfaction equivalent to those without major complications. This information allows a physician to counsel patients on the fact that a complication creates frustration, cost, and inconvenience; however, it does not appear to adversely affect clinically meaningful long-term outcomes and satisfaction. FAU - Chotai, Silky AU - Chotai S AD - Departments of 1 Orthopaedic Surgery and AD - Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and FAU - Parker, Scott L AU - Parker SL AD - Departments of 1 Orthopaedic Surgery and AD - Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and FAU - Sivaganesan, Ahilan AU - Sivaganesan A AD - Departments of 1 Orthopaedic Surgery and AD - Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and FAU - Sielatycki, J Alex AU - Sielatycki JA AD - Departments of 1 Orthopaedic Surgery and AD - Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and FAU - Asher, Anthony L AU - Asher AL AD - Department of Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - McGirt, Matthew J AU - McGirt MJ AD - Department of Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina. FAU - Devin, Clinton J AU - Devin CJ AD - Departments of 1 Orthopaedic Surgery and AD - Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and LA - eng PT - Journal Article PL - United States TA - Neurosurg Focus JT - Neurosurgical focus JID - 100896471 SB - IM MH - Adult MH - Aged MH - Disability Evaluation MH - Elective Surgical Procedures/*adverse effects/methods MH - Female MH - Humans MH - Longitudinal Studies MH - Lumbosacral Region/*surgery MH - Male MH - Middle Aged MH - Neurodegenerative Diseases/*surgery MH - Pain Measurement MH - *Patient Outcome Assessment MH - Patient Satisfaction MH - Postoperative Complications/*physiopathology MH - Surveys and Questionnaires MH - Time Factors MH - *Treatment Outcome OTO - NOTNLM OT - BMI = body mass index OT - BP = back pain OT - LP = leg pain OT - MCID = minimum clinically significant difference OT - MCS = Mental Component Summary OT - MI = myocardial infarction OT - ODI = Oswestry Disability Index OT - PCS = Physical Component Summary OT - PRO = patient-reported outcome OT - clinically significant OT - complications OT - lumbar OT - patient-reported outcomes OT - satisfaction OT - spine surgery EDAT- 2015/12/02 06:00 MHDA- 2016/09/14 06:00 CRDT- 2015/12/02 06:00 PHST- 2015/12/02 06:00 [entrez] PHST- 2015/12/02 06:00 [pubmed] PHST- 2016/09/14 06:00 [medline] AID - 10.3171/2015.8.FOCUS15302 [doi] PST - ppublish SO - Neurosurg Focus. 2015 Dec;39(6):E8. doi: 10.3171/2015.8.FOCUS15302.