PMID- 33560010
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20231002
IS  - 2380-0194 (Electronic)
IS  - 2380-0186 (Linking)
VI  - 34
IP  - 7
DP  - 2021 Aug 1
TI  - The Influence of Comorbidity on Postoperative Outcomes Following Lumbar 
      Decompression.
PG  - E390-E396
LID - 10.1097/BSD.0000000000001133 [doi]
AB  - STUDY DESIGN: Retrospective. OBJECTIVE: Evaluate the association between 
      comorbidity burden and reaching minimum clinically important difference (MCID) 
      following lumbar decompression (LD). SUMMARY OF BACKGROUND DATA: There is limited 
      research on the influence of preoperative comorbidity burden on patient-reported 
      outcome improvement following LD. METHODS: A prospectively maintained surgical 
      registry was retrospectively reviewed for eligible spine surgeries between 2015 
      and 2019. Inclusion criteria were primary, single, or multilevel LD. Patients 
      were excluded for missing preoperative patient-reported outcome surveys. 
      Stratification was based on Charlson Comorbidity Index (CCI) score: 0 points (no 
      comorbidities), 1-2 points (low CCI), >/=3 points (high CCI). Demographics and 
      perioperative characteristics were evaluated for differences. Linear regression 
      assessed postoperative improvement for visual analogue scale (VAS) back, VAS leg, 
      Oswestry disability index (ODI), Short Form-12 Physical Composite Score (SF-12 
      PCS), and Patient-Reported Outcomes Measurement Information System physical 
      function (PROMIS-PF) scores through 1 year. Achievement rate of MCID was compared 
      between groups and evaluated for significant predictors. RESULTS: Three hundred 
      fourteen patients were included (123 no comorbidities, 100 low CCI, 91 high CCI). 
      Higher CCI patients were older, more likely to smoke, and have comorbid diseases 
      (all P<0.001). Perioperative differences included increased operative time, 
      levels decompressed, length of stay, and discharge day in the CCI>/=3 group. No 
      differences in the rate of achieving MCID for VAS back, VAS leg, and ODI. CCI>/=3 
      subgroup had a lower rate of reaching MCID at 6 months for SF-12 PCS, at 6 weeks 
      for PROMIS-PF, and the overall rate for both SF-12 PCS and PROMIS-PF (all 
      P<0.05). Multilevel procedures was a predictor for MCID achievement for ODI. 
      CONCLUSIONS: Patients with increased comorbidities undergoing LD had an 
      equivalent MCID achievement rate for pain and disability metrics through 1 year. 
      High CCI patients did, however, have a lower rate of achieving MCID for their 
      physical function surveys which suggests that comorbidity burden influences 
      improvement in physical function following LD.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Nolte, Michael T
AU  - Nolte MT
AD  - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
FAU - Parrish, James M
AU  - Parrish JM
FAU - Jenkins, Nathaniel W
AU  - Jenkins NW
FAU - Cha, Elliot D K
AU  - Cha EDK
FAU - Lynch, Conor P
AU  - Lynch CP
FAU - Mohan, Shruthi
AU  - Mohan S
FAU - Geoghegan, Cara E
AU  - Geoghegan CE
FAU - Jadczak, Caroline N
AU  - Jadczak CN
FAU - Hrynewycz, Nadia M
AU  - Hrynewycz NM
FAU - Singh, Kern
AU  - Singh K
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Spine Surg
JT  - Clinical spine surgery
JID - 101675083
SB  - IM
MH  - Comorbidity
MH  - *Decompression
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - *Lumbosacral Region
MH  - Pain Measurement
MH  - Retrospective Studies
MH  - Treatment Outcome
COIS- The authors declare no conflict of interest.
EDAT- 2021/02/10 06:00
MHDA- 2021/10/26 06:00
CRDT- 2021/02/09 11:19
PHST- 2020/05/04 00:00 [received]
PHST- 2020/12/22 00:00 [accepted]
PHST- 2021/02/10 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2021/02/09 11:19 [entrez]
AID - 01933606-202108000-00009 [pii]
AID - 10.1097/BSD.0000000000001133 [doi]
PST - ppublish
SO  - Clin Spine Surg. 2021 Aug 1;34(7):E390-E396. doi: 10.1097/BSD.0000000000001133.