Patient-oriented outcomes from low back surgery - A community-based study

Study Design. This study used a prospective cohort design. Objective: To examine factors associated with favorable self-reported patie nt outcomes 1 year after elective surgery for degenerative back problems. Summary of Background Data. Many previous studies addressing the results of low back surgery have been conducted in academic institutions or by single surgeons. As part of a quality improvement effort, surgeons in private pra ctice led a community-based outcomes management project in Washington Stale . Methods. Patients ages 18 and older with the following diagnoses were eligi ble for the study: degenerative changes, herniated disc, instability, and s pinal stenosis. Nine orthopedists and neurosurgeons enrolled a total of 281 patients. Participants were asked to complete baseline and 1-year follow-u p surveys. Data concerning diagnoses, clinical signs, and operative procedu res were provided by the surgeons. The researchers examined sociodemographi c characteristics, self-reported symptoms before surgery, preoperative clin ical signs, diagnoses, and operative procedures associated with three prima ry outcomes: better functioning, improved quality of life, and overall trea tment satisfaction. Results. Follow-up surveys were completed by 236 (84%) of the enrolled pati ents. Approximately two thirds of the study participants reported much bett er functioning (65%), a great quality of life improvement (64%), and a very positive perspective about their treatment outcome (68%). The following va riables were associated with worse patient outcomes: older age, previous lo w back surgery, workers' compensation coverage, and consultation with an at torney before surgery. Patients undergoing a fusion procedure were more lik ely to report good outcomes. Conclusions. The authors' experience indicates that community-based outcome s data collection efforts:are feasible and can be incorporated into usual c linical practice. The study results indicate that compensation payments and litigation are two important predictors of poor outcomes after low back su rgery in community practice. Because of small numbers, varied diagnoses, an d possible selection bias, the findings with respect to fusion should be in terpreted cautiously.