Abstract
PurposeIt is unknown which chronic low back pain (CLBP) patients are typically referred to spinal surgery. The present study, therefore, aimed to explore which patient-reported factors are predictive of spinal surgery referral among CLBP patients.MethodsCLBP patients were consecutively recruited from a Dutch orthopedic hospital specialized in spine care (n = 4987). The outcome of this study was referral to spinal surgery (yes/no), and was assessed using hospital records. Possible predictive factors were assessed using a screening questionnaire. A prediction model was constructed using logistic regression, with backwards selection and p < 0.10 for keeping variables in the model. The model was internally validated and evaluated using discrimination and calibration measures.ResultsFemale gender, previous back surgery, high intensity leg pain, somatization, and positive treatment expectations increased the odds of being referred to spinal surgery, while being obese, having comorbidities, pain in the thoracic spine, increased walking distance, and consultation location decreased the odds. The model’s fit was good (X2 = 10.5; p = 0.23), its discriminative ability was poor (AUC = 0.671), and its explained variance was low (5.5%). A post hoc analysis indicated that consultation location was significantly associated with spinal surgery referral, even after correcting for case-mix variables.ConclusionSome patient-reported factors could be identified that are predictive of spinal surgery referral. Although the identified factors are known as common predictive factors of surgery outcome, they could only partly predict spinal surgery referral.
Highlights
The burden of low back pain (LBP) for society is larger than that of any other medical condition [1]
A post hoc analysis indicated that consultation location was significantly associated with spinal surgery referral, even after correcting for case-mix variables
It would be insightful to know which chronic low back pain (CLBP) patients are typically referred to spinal surgery, whether patient-reported factors can be identified that are predictive of spinal surgery referral, and if so, to what extent spinal surgery referral is explained by these factors
Summary
The burden of low back pain (LBP) for society is larger than that of any other medical condition [1]. Even though not life-threatening, CLBP has serious consequences for the patients’ overall wellbeing (e.g., reduced health-related quality of life) and is associated with a high economic burden. To illustrate the latter, the total cost of back pain to Dutch society was estimated to be €3.5 billion [1,2,3]. Spinal surgeries represent a sizeable proportion of the total cost of back pain [3], but spinal surgery rates vary extensively across, and even within, countries [4] These variations in spinal surgery rates seem to indicate a lack of professional consensus. Proper patient referral and selection is expected to improve the outcome of spinal surgery [6, 8, 9] but no classification system currently exists that is supported by sufficient evidence to be broadly implemented [8, 10]
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