The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Oliver G S Ayling; Tamir Ailon; John T Street; Nicolas Dea; Greg McIntosh; Edward Abraham; W Bradly Jacobs; Alex Soroceanu; Michael G Johnson; Jerome Paquet; Parham Rasoulinejad; Phillipe Phan; Albert Yee; Sean Christie; Andrew Nataraj; R Andrew Glennie; Hamilton Hall; Neil Manson; Y Raja Rampersaud; Kenneth Thomas; Charles G Fisher

doi:10.1093/neuros/nyaa427

The Effect of Perioperative Adverse Events on Long-Term Patient-Reported Outcomes After Lumbar Spine Surgery

Neurosurgery. 2021 Jan 13;88(2):420-427. doi: 10.1093/neuros/nyaa427.

Authors

Oliver G S Ayling¹, Tamir Ailon¹, John T Street¹, Nicolas Dea¹, Greg McIntosh², Edward Abraham³, W Bradly Jacobs⁴, Alex Soroceanu⁴, Michael G Johnson⁵, Jerome Paquet⁶, Parham Rasoulinejad⁷, Phillipe Phan⁸, Albert Yee⁹, Sean Christie¹⁰, Andrew Nataraj¹¹, R Andrew Glennie¹⁰, Hamilton Hall⁹, Neil Manson³, Y Raja Rampersaud⁹, Kenneth Thomas⁴, Charles G Fisher¹

Affiliations

¹ Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, Canada.
² Canadian Spine Society, Markdale, Canada.
³ Department of Surgery, Canada East Spine Centre, Saint John, Canada.
⁴ Department of Surgery, University of Calgary, Calgary, Canada.
⁵ Departments of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Canada.
⁶ Department of Surgery, Laval University, Quebec City, Canada.
⁷ Department of Surgery, University of Western Ontario, London, Canada.
⁸ Department of Surgery, University of Ottawa, Ottawa, Canada.
⁹ Department of Surgery, University of Toronto, Toronto, Canada.
¹⁰ Department of Surgery, Dalhousie University, Halifax, Canada.
¹¹ Department of Surgery, University of Alberta, Edmonton, Canada.

PMID: 33009559
DOI: 10.1093/neuros/nyaa427

Abstract

Background: Perioperative adverse events (AEs) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes.

Objective: To examine perioperative AEs and their impact on outcome after lumbar spine surgery.

Methods: A total of 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3, 12, and 24 mo postoperatively included the Owestry Disability Index (ODI), 12-Item Short-Form Health Survey (SF-12) Physical (PCS) and Mental (MCS) Component Summary scales, visual analog scale (VAS) leg and back, EuroQol-5D (EQ5D), and satisfaction.

Results: AEs occurred in 767 (21.6%) patients, and 85 (2.4%) patients suffered major AEs. Patients with major AEs had worse ODI scores and did not reach minimum clinically important differences at 2 yr (no AE: 25.7 ± 19.2, major: 36.4 ± 19.1, P < .001). Major AEs were associated with worse ODI scores on multivariable linear regression (P = .011). PCS scores were lower after major AEs (43.8 ± 9.5, vs 37.7 ± 20.3, P = .002). On VAS leg and back and EQ5D, the 2-yr outcomes were significantly different between the major and no AE groups (<0.01), but these differences were small (VAS leg: 3.4 ± 3.0 vs 4.0 ± 3.3; VAS back: 3.5 ± 2.7 vs 4.5 ± 2.6; EQ5D: 0.75 ± 0.2 vs 0.64 ± 0.2). SF12 MCS scores were not different. Rates of satisfaction were lower after major AEs (no AE: 84.6%, major: 72.3%, P < .05).

Conclusion: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing AEs.

Keywords: Adverse events; Complications; Patient-reported outcomes; Spine surgery.

MeSH terms

Adult
Aged
Canada
Disability Evaluation
Female
Humans
Lumbar Vertebrae / surgery
Male
Middle Aged
Neurosurgical Procedures / adverse effects*
Patient Reported Outcome Measures
Postoperative Complications / epidemiology*
Spinal Diseases / surgery*
Treatment Outcome*