Are there differences in pre-operative expectations for pain relief and functional wellbeing between primary and revision surgery groups in adult elective lumbar spinal surgery patients?
Pre-operative expectations do not differ between primary and revision lumbar spine surgery patients, indicating that prior surgical experience does not alter patient expectations.
Addressing pre-operative expectations is important for realistic surgical outcomes, enhance satisfaction, support informed decisions, and ensure valid informed consent. Here, we determine if there are differences in pre-operative expectations (specifically in the domains of pain relief and overall functional wellbeing) between primary and revision surgery groups in adult Canadian elective lumbar spinal surgery patients. This multicenter, retrospective cohort study analyzed adult elective lumbar spine surgery patients enrolled in Canadian Spine Outcomes and Research Network from 2017 to 2023. Two cohorts of interest 1) Patients undergoing posterior decompression alone and 2) those undergoing posterior decompression with fusion. These were further divided into primary and revision surgery groups. Exclusion criteria included patients undergoing surgery for trauma, tumors, infection, or those who underwent anterior-only approaches. Expectation scores were divided into two dimensions: overall functional well-being (independence, physical activity, mental well-being, social contacts, and general physical) and pain relief (leg and back pain). For each category, patients rated expected outcomes on a scale from 0 (no change) to 3 (much better). Each score was calculated by summing points for items in each dimension, divided by the total possible maximum, where higher scores indicate higher pre-operative expectations. Propensity score matching (PSM) was used to create a balanced comparison between primary and revision surgery groups within both cohorts, adjusting for confounders such as age, sex, labor force status, number of comorbidities, depressive symptoms, primary pathology, physical activity, leg and back pain, and self-rated health status . Greedy algorithm with nearest neighbor matching and 0.2 caliper was used to balance baseline covariates between groups. Our total patient population was 6,353 patients, with 3,050 undergoing decompressions alone, of which 2,843 are primary surgery patients and 207 are revision surgery patients. The remaining patients underwent decompression and fusion, of which 2,825 were primary surgery patients, and 478 were revision surgery patients. After matching, in the decompression alone cohort there was no significant difference in pain relief expectation scores between primary (n=181) mean = 2.49 (±0.63) and revision surgery patients (n=181) mean 2.45 (±0.63, p=0.3455), nor in overall functional wellbeing scores (primary mean = 2.22 (±0.63); revision mean =2.19 (±0.62), p=0.469). Additionally, in the decompression and fusion cohort there was no significant difference in overall functional wellbeing expectation scores between (n=180) in primary surgery patients (n=432)(mean = 2.24 (±0.66); n = 180) and in revision surgery patients (432) (mean = 2.12 (±0.68), p=0.095; n = 178), nor in pain relief scores (primary mean = 2.53 (±0.63); revision mean =2.41 (±0.69), p=0.469). There were no differences seen in pre-operative expectations between primary and revision patients, despite the revision patients having previous experience with surgery. Surgeons should maintain consistent pre-operative discussions for both primary and revision surgery patients.
Skaik et al. (Wed,) studied this question.