The Impact of COVID-19 Surges in 2019-2021 on Patient-Reported Outcome Measures After Spine Surgery at an Academic Tertiary Referral Center in Taiwan: A Retrospective Observational Cohort Study

Yu-Hsien Lin; Jun-Sing Wang; Wen-Chien Wang; Yu-Tsung Lin; Yun-Che Wu; Kun-Hui Chen; Chien-Chou Pan; Ning-Chien Chin; Cheng-Min Shih; Cheng-Hung Lee

doi:10.3389/fsurg.2022.853441

The Impact of COVID-19 Surges in 2019-2021 on Patient-Reported Outcome Measures After Spine Surgery at an Academic Tertiary Referral Center in Taiwan: A Retrospective Observational Cohort Study

Front Surg. 2022 Mar 17:9:853441. doi: 10.3389/fsurg.2022.853441. eCollection 2022.

Authors

Yu-Hsien Lin¹, Jun-Sing Wang^{2

3

4

5}, Wen-Chien Wang¹, Yu-Tsung Lin¹, Yun-Che Wu¹, Kun-Hui Chen^{1

5

6}, Chien-Chou Pan^{1

7}, Ning-Chien Chin¹, Cheng-Min Shih^{1

5

8}, Cheng-Hung Lee^{1

5

9}

Affiliations

¹ Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
⁵ College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁶ Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan.
⁷ Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan.
⁸ Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.
⁹ Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.

Abstract

Aim: Limited data are available on the impact of the coronavirus disease 2019 (COVID-19) pandemic on patient-reported outcome measures (PROMs) in patients who underwent spine surgery. In this study, we aimed to investigate the associations between the COVID-19 outbreak in Taiwan (May 2021) and PROMs in patients who underwent spine surgery.

Method: We retrospectively identified patients who underwent spine surgery during identical defined 6-week time-intervals (May 16 to June 30) in 2019, 2020, and 2021. PROMs, including visual analog scale (VAS) score for pain, Oswestry disability index (ODI), and EuroQol-5D (EQ-5D), were investigated before surgical intervention and at a 1-month follow-up. Relevant clinical information was collected from the electronic medical records of patients. Linear regression analysis was used to examine the association between the pandemic in 2021 (vs. 2019/2020) and the PROMs after adjusting for age, sex, and relevant clinical variables.

Results: The number of patients who underwent spine surgery at our hospital during the identical defined 6-week time-intervals in 2019, 2020, and 2021 was 77, 70, and 48, respectively. The surgical intervention significantly improved VAS, ODI, and EQ-5D of the patients (1 month after surgery vs. before surgery, all p < 0.001) in all three study periods. However, there was a significant between-group difference in change from baseline in VAS (p = 0.002) and EQ-5D (p = 0.010). The decrease in VAS and increase in EQ-5D after surgery in 2021 were not as much as those in 2019 and 2020. The associations between the pandemic in 2021 (vs. 2019/2020) and changes in VAS (β coefficient 1.239; 95% confidence interval [CI] 0.355 to 2.124; p = 0.006) and EQ-5D (β coefficient, -0.095; 95% CI, -0.155 to -0.035; p = 0.002) after spine surgery were independent of relevant clinical factors.

Conclusion: There was less improvement in short-term PROMs (VAS and EQ-5D) after spine surgery during the COVID-19 pandemic. Assessment of PROMs in surgical patients during a pandemic may be clinically relevant, and psychological support in this condition might help improve patients' outcomes.

Keywords: coronavirus disease 2019; health care quality; pandemic; patient report outcome; spine surgery.