Abstract
Purpose
The ageing of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery.
Methods
3,549/4,053 patients with degenerative lumbar disorders, undergoing surgery with the goal of pain relief, completed the multidimensional Core Outcome Measures Index (COMI; scored 0–10) before and 12 months after surgery. At 12 months postoperatively, they also rated the global treatment outcome and their satisfaction with care. Using the Eurospine Spine Tango Registry, surgeons documented surgical details, American Society of Anesthesiologists comorbidity (ASA) grades and perioperative surgical and general complications.
Results
29.0 % patients were rated as ASA1 (normal healthy), 45.7 % as ASA2 (mild/moderate systemic disease), 24.9 % as ASA3 (severe), and just 0.4 % as ASA4 (life-threatening). In going from ASA1 to ASA3 (ASA4 group too small), surgical complications increased significantly from 5.0 to 14.5 % and general complications increased from 2.9 to 15.7 %; 12-month outcomes showed a corresponding decline, with a good global outcome being reported by 79 % ASA1 patients, 76 % ASA2, and 68 % ASA3. Satisfaction with treatment was 87, 85, and 79 %, respectively, and reduction in COMI was 4.2 ± 2.9, 3.7 ± 3.0, and 3.4 ± 3.0 points, respectively. Multiple regression analysis revealed a significant (p < 0.0001) independent effect of ASA grade on both complications and outcome.
Conclusion
The negative impact of comorbidity on the outcome of spine surgery has not been well investigated/quantified to date. The ASA grade may be helpful in producing algorithms for decision-making and preoperative counselling regarding the corresponding risks and benefits of surgery.
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References
Haub C (2011) World population aging: clocks illustrate growth in population under age 5 and over age 65. http://www.prb.org/Publications/Articles/2011/agingpopulationclocks.aspx
Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA (2001) Causes and consequences of comorbidity: a review. J Clin Epidemiol 54:661–674. doi:10.1016/S0895-4356(00)00363-2
Ciol MA, Deyo RA, Howell E, Kreif S (1996) An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 44:285–290
Slover J, Abdu WA, Hanscom B, Lurie J, Weinstein JN (2006) Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores. Spine 31:1265–1271
Dunbar MJ, Robertsson O, Ryd L (2004) What’s all that noise? The effect of co-morbidity on health outcome questionnaire results after knee arthroplasty. Acta Orthop Scand 75:119–126. doi:10.1080/00016470412331294355
Imamura K, Black N (1998) Does comorbidity affect the outcome of surgery? Total hip replacement in the UK and Japan. Int J Qual Health Care 10:113–123
Slover J, Abdu WA, Hanscom B, Weinstein JN (2006) The impact of comorbidities on the change in short-form 36 and Oswestry scores following lumbar spine surgery. Spine 31:1974–1980
Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026
Mannion AF, Porchet F, Kleinstück F, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: The Core Outcome Measures Index (COMI) in clinical practice. Eur Spine J 18:367–373
Bjorgul K, Novicoff WM, Saleh KJ (2010) American Society of Anesthesiologist Physical Status score may be used as a comorbidity index in hip fracture surgery. J Arthroplasty 25:134–137. doi:10.1016/j.arth.2010.04.010
Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 2. Minimal clinically important difference for improvement and deterioration as measured with the Core Outcome Measures Index. Eur Spine J 18:374–379
Rothoerl RD, Woertgen C, Holzschuh M, Schlaier J (1998) Are there differences in the symptoms, signs and outcome after lumbar disc surgery in the elderly compared with younger patients? Br J Neurosurg 12:250–253
Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F, Grob D (2009) Great expectations: really the novel predictor of outcome after spinal surgery? Spine 34:1590–1599
Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 11:203–209
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Mannion, A.F., Fekete, T.F., Porchet, F. et al. The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders. Eur Spine J 23 (Suppl 1), 66–71 (2014). https://doi.org/10.1007/s00586-014-3189-y
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DOI: https://doi.org/10.1007/s00586-014-3189-y