Characteristics and predicted outcome of patients lost to follow-up after degenerative lumbar spine surgery

Parai, Catharina; Hägg, Olle; Willers, Carl; Lind, Bengt; Brisby, Helena

doi:10.1007/s00586-020-06528-y

Cited by 22 publications

(19 citation statements)

References 16 publications

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“…The yearly updating of the database and introduction of new baseline variables are also expected to increase the precision of the model on the individual level over time. Dropouts may have a tendency of worse outcome than consenters also in registers [28], so there is a possible risk of overestimating success in the model. However, this is still an unsolved question [29].…”

Section: Discussionmentioning

confidence: 99%

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Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register

2021

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Purpose To evaluate the predictive precision of the Dialogue Support, a tool for additional help in shared decision-making before surgery of the degenerative spine. Methods Data in Swespine (Swedish national quality registry) of patients operated between 2007 and 2019 found the development of prediction algorithms based on logistic regression analyses, where socio-demographic and baseline variables were included. The algorithms were tested in four diagnostic groups: lumbar disc herniation, lumbar spinal stenosis, degenerative disc disease and cervical radiculopathy. By random selection, 80% of the study population was used for the prediction of outcome and then tested against the actual outcome of the remaining 20%. Outcome measures were global assessment of pain (GA), and satisfaction with outcome. Results Calibration plots demonstrated a high degree of concordance on a group level. On an individual level, ROC curves showed moderate predictive capacity with AUC (area under the curve) values 0.67–0.68 for global assessment and 0.6–0.67 for satisfaction. Conclusion The Dialogue Support can serve as an aid to both patient and surgeon when discussing and deciding on surgical treatment of degenerative conditions in the lumbar and cervical spine. Level of evidence I.

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Section: Discussionmentioning

confidence: 99%

“…A second possible cause of selection bias would be loss to follow-up. This has been assessed in a recent publication [28].…”

Section: Discussionmentioning

confidence: 99%

Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register

2021

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“…Fifth, postoperative data were missing or incomplete for 59 of 228 (25%) of the patients in the fusion group and for 45 of 144 (31%) patients in decompression group. For Swespine, Parai et al 24 reported that patients who are lost to follow-up demonstrate somewhat worse outcome than follow-up responders. This means that the true treatment effects might be lower than the values reported by our study.…”

Section: Discussionmentioning

confidence: 99%

Reoperations after decompression with or without fusion for L4–5 spinal stenosis with or without degenerative spondylolisthesis: a study of 6,532 patients in Swespine, the national Swedish spine register

et al. 2021

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Background and purpose — There are different opinions on how to surgically address lumbar spinal stenosis with concomitant degenerative spondylolisthesis (DS). We investigated reoperation rates at the index and adjacent levels after L4–5 fusion surgery in a large cohort of unselected patients registered in Swespine, the national Swedish spine register. Patients and methods — 6,532 patients, who underwent surgery for L4–5 spinal stenosis with or without DS between 2007 and 2012, were followed up to 2017 to identify reoperations at the index and adjacent levels. The reoperation rates for decompression and fusion were compared with the reoperation rates for decompression only and for patients with or without DS. Patient-reported outcome data were collected preoperatively, and at 1 and 2 years after surgery and used to evaluate differences in outcome between index operations and reoperations. Results — For spinal stenosis with DS, the reoperation rate at the index level was 3.0% for decompression and fusion and 6.0% for decompression only. At the adjacent level, the corresponding numbers were 9.7% and 4.2% respectively. For spinal stenosis without DS, the reoperation rate at the index level was 3.7% for decompression and fusion and 6.2% after decompression only. At the adjacent level, the corresponding numbers were 8.1% and 3.8% respectively. For the reoperations at the adjacent level, there was no difference in patient-reported outcome between extended fusion or decompression only. Interpretation — Single-level lumbar fusion surgery is associated with an increased rate of reoperations at the adjacent level compared with decompression only. When reoperations at the index level are included there is no difference in reoperation rates between fusion and decompression only.

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“…Strengths of this study include a large patient material and the use of validated PROMs. 29% of the patients did not have complete data and were excluded; however, a loss of 30% have been reported to not influence the outcome in spine register studies [15], but conflicting opinions has also been reported [16].…”

Section: Discussionmentioning

confidence: 99%

Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery

2021

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Purpose Most patients with lumbar disc herniations requiring surgery have concomitant back pain. The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP). Methods 15,418 patients surgically treated due to LDH with primary discectomy from 1998 until 2020 were included in the study. Self-reported low back pain assessed with a numerical rating scale (NRS) was used to dichotomize the patients in two groups, patients without preoperative back pain (NBP, NRS = 0, n = 1333, 9%) and patients with preoperative low back pain (LBP, NRS > 0, n = 14,085, 91%). Patient reported outcome measures (PROMs) collected preoperatively and one-year postoperatively were used to evaluate differences in outcomes between the groups. Results At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. Significant improvement regarding leg pain was seen in all measured PROMs in both groups oneyear after surgery. In the NBP group, 13% reported clinically significant back pain (NRS difference greater than Minimally Clinical Important Difference (MICD)) at the one-year follow-up. Conclusions Patients without preoperative back pain are good candidates for LDH surgery. 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery.

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Characteristics and predicted outcome of patients lost to follow-up after degenerative lumbar spine surgery

Cited by 22 publications

References 16 publications

Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register

Prediction of outcome after spinal surgery—using The Dialogue Support based on the Swedish national quality register

Reoperations after decompression with or without fusion for L4–5 spinal stenosis with or without degenerative spondylolisthesis: a study of 6,532 patients in Swespine, the national Swedish spine register

Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery

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