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Neurosurg Focus. 2018 Jan;44(1):E3. doi: 10.3171/2017.10.FOCUS17553.

Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database.

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1Department of Neurological Surgery, University of California, San Francisco, California.
2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
4Norton Leatherman Spine Center, Louisville, Kentucky.
5Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee.
6Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
7Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
8Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery & Spine Associates, Charlotte, North Carolina.
9Atlantic Neurosurgical Specialists, Morristown, New Jersey.
10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan.
11Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York.
12Geisinger Health, Danville, Pennsylvania.
13Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee.
14Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and.
15Atlanta Brain and Spine Care, Atlanta, Georgia.


OBJECTIVE The American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing results from recent randomized controlled trials have established a need to clarify the groups that would most benefit from surgery for degenerative lumbar spondylolisthesis. In the present study, the authors compared patients who were the most and the least satisfied following surgery for degenerative lumbar spondylolisthesis. METHODS This was a retrospective analysis of a prospective, national longitudinal registry including patients who had undergone surgery for grade 1 degenerative lumbar spondylolisthesis. The most and least satisfied patients were identified based on an answer of "1" and "4," respectively, on the North American Spine Society (NASS) Satisfaction Questionnaire 12 months postoperatively. Baseline demographics, clinical variables, surgical parameters, and outcomes were collected. Patient-reported outcome measures, including the Numeric Rating Scale (NRS) for back pain, NRS for leg pain, Oswestry Disability Index (ODI), and EQ-5D (the EuroQol health survey), were administered at baseline and 3 and 12 months after treatment. RESULTS Four hundred seventy-seven patients underwent surgery for grade 1 degenerative lumbar spondylolisthesis in the period from July 2014 through December 2015. Two hundred fifty-five patients (53.5%) were the most satisfied and 26 (5.5%) were the least satisfied. Compared with the most satisfied patients, the least satisfied ones more often had coronary artery disease (CAD; 26.9% vs 12.2%, p = 0.04) and had higher body mass indices (32.9 ± 6.5 vs 30.0 ± 6.0 kg/m2, p = 0.02). In the multivariate analysis, female sex (OR 2.9, p = 0.02) was associated with the most satisfaction. Notably, the American Society of Anesthesiologists (ASA) class, smoking, psychiatric comorbidity, and employment status were not significantly associated with satisfaction. Although there were no significant differences at baseline, the most satisfied patients had significantly lower NRS back and leg pain and ODI scores and a greater EQ-5D score at 3 and 12 months postoperatively (p < 0.001 for all). CONCLUSIONS This study revealed that some patient factors differ between those who report the most and those who report the least satisfaction after surgery for degenerative lumbar spondylolisthesis. Patients reporting the least satisfaction tended to have CAD or were obese. Female sex was associated with the most satisfaction when adjusting for potential covariates. These findings highlight several key factors that could aid in setting expectations for outcomes following surgery for degenerative lumbar spondylolisthesis.


ASA = American Society of Anesthesiologists; BMI = body mass index; CAD = coronary artery disease; MI = minimally invasive; NASS = North American Spine Society; NRS-BP = Numeric Rating Scale for back pain; NRS-LP = NRS for leg pain; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; Quality Outcomes Database; VA = Veterans Affairs; lumbar; patient-reported outcomes; satisfaction; spondylolisthesis


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