Patient-reported Outcomes following Elective Surgery for Lumbar Degenerative Disease: Effect of Peri-operative Complications on Outcomes

Abstract

Introduction There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency when looking at large aggregate datasets. Understanding how complications affect long-term patient reported outcomes (PROs), following degenerative lumbar surgery, is vital. Our hypothesis was that 90-day complications would adversely affect long term PROs compared with a cohort that did not experience a complication. Methods 906 consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of four-years were enrolled into a prospective longitudinal registry. PROs: ODI, NRS-Back and leg pain (BP, LP), Quality of life (EQ-5D), and NASS satisfaction questionnaire were recorded at baseline and 12-month follow-up. Complications were divided into major (surgical site infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and MI) and minor (urinary tract infection, pneumonia and deep venous thrombosis). Results Thirteen percent (118) of patients developed complications: (major-12% (108) and 8% (68)-minor) within 90-days after surgery. The patients with complications had significantly higher ODI scores at 12-months (29.43 ± 17.7 versus 25.2 ± 18.33, p = 0.02) after surgery. In a multivariable linear regression analysis, after controlling for array of preoperative variables, the occurrence of a major complication was not associated with worsening ODI scores 12-month after surgery. There was no difference in the percent of patients achieving minimal clinically important difference MCID for disability (66% vs 64%), back (55% vs 56%) and leg pain (62% vs 59%), quality of life (19% vs14%) and patient satisfaction rates (82% vs 80%) between those without and with major complications. Conclusion The occurrence of major complications did not significantly affect the PROs 12-month after surgery. These patients achieve clinically meaningful outcomes and patient satisfaction, as much as those without complication. This information allows a physician to council 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.