Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective Quality Outcomes Database registry

View More View Less
  • 1 Norton Leatherman Spine Center, Louisville, Kentucky;
  • 2 Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;
  • 3 Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts;
  • 4 Department of Neurosurgery, University of Utah Health Care, Salt Lake City, Utah; and
  • 5 Department of Neurosurgery, University of California, San Francisco Medical Center–Spine Center, San Francisco, California
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Medical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.

METHODS

The Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.

RESULTS

Of 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.

CONCLUSIONS

MCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

ABBREVIATIONS ES = effect size; MCID = minimum clinically important difference; MDC = minimum detectable change; NASS = North American Spine Society; NRS = numeric rating scale; NRS-BP = NRS for back pain; NRS-LP = NRS for leg pain; ODI = Oswestry Disability Index; PD = psychiatric disease; PRO = patient-reported outcome; QOD = Quality Outcomes Database; ROC = receiver operating characteristic; SCB = substantial clinical benefit; SEM = standard error of measurement.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. leah.carreon@nortonhealthcare.org.

INCLUDE WHEN CITING Published online July 24, 2020; DOI: 10.3171/2020.4.SPINE20296.

Disclosures Dr. Laratta reports being a consultant for Stryker, 4Web, Medtronic, NuVasive, K2M, Evolution Spine, and Spineart and receiving royalties from Evolution Spine. Dr. Carreon reports being an employee of Norton Healthcare and the University of Southern Denmark; being a consultant for the National Spine Health Foundation; overseeing non–study-related institutional research funded by OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corp., IntelliRod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance; and having nonfinancial relationships as a member of the editorial advisory boards for Spine Deformity, The Spine Journal, and Spine and the University of Louisville IRB. Dr. Buchholz reports being a consultant for Medtronic and NuVasive. Dr. Bisson reports being a consultant for Stryker and MiRus and receiving clinical or research support for the study described (includes equipment or material) from NREF. Dr. Mummaneni reports being a consultant for DePuy Synthes, Globus, and Stryker; having direct stock ownership in Spinicity/ISD; receiving clinical or research support for the study described (includes equipment or material) from NREF; overseeing non–study-related clinical or research efforts receiving support from AO Spine and ISSG; and receiving royalties from DePuy Synthes, Thieme Publishers, and Springer.

  • 1

    Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822w831.

    • Search Google Scholar
    • Export Citation
  • 2

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806814.

    • Search Google Scholar
    • Export Citation
  • 3

    Samartzis D, Karppinen J, Cheung JP, Lotz J. Disk degeneration and low back pain: are they fat-related conditions? Global Spine J. 2013;3(3):133144.

    • Search Google Scholar
    • Export Citation
  • 4

    Shiri R, Solovieva S, Husgafvel-Pursiainen K, The role of obesity and physical activity in non-specific and radiating low back pain: the Young Finns study. Semin Arthritis Rheum. 2013;42(6):640650.

    • Search Google Scholar
    • Export Citation
  • 5

    Buerba RA, Fu MC, Gruskay JA, Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database. Spine J. 2014;14(9):20082018.

    • Search Google Scholar
    • Export Citation
  • 6

    Marquez-Lara A, Nandyala SV, Sankaranarayanan S, Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine (Phila Pa 1976). 2014;39(10):798804.

    • Search Google Scholar
    • Export Citation
  • 7

    Patel N, Bagan B, Vadera S, Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007;6(4):291297.

  • 8

    Rihn JA, Radcliff K, Hilibrand AS, Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2012;37(23):19331946.

    • Search Google Scholar
    • Export Citation
  • 9

    Djurasovic M, Bratcher KR, Glassman SD, The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976). 2008;33(16):17891792.

    • Search Google Scholar
    • Export Citation
  • 10

    Goh GS, Liow MHL, Yeo W, The influence of body mass index on functional outcomes, satisfaction, and return to work after single-level minimally-invasive transforaminal lumbar interbody fusion: a five-year follow-up study. Spine (Phila Pa 1976). 2019;44(11):809817.

    • Search Google Scholar
    • Export Citation
  • 11

    Joseph JR, Farooqui Z, Smith BW, Does clinical improvement of symptomatic degenerative lumbar disease impact obesity? J Neurosurg Spine. 2017;26(6):705708.

    • Search Google Scholar
    • Export Citation
  • 12

    Burgstaller JM, Held U, Brunner F, The impact of obesity on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS): a Swiss prospective multicenter cohort study. Spine (Phila Pa 1976). 2016;41(1):8289.

    • Search Google Scholar
    • Export Citation
  • 13

    Pinheiro MB, Ferreira ML, Refshauge K, Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J. 2016;16(1):105116.

    • Search Google Scholar
    • Export Citation
  • 14

    Pinheiro MB, Ferreira ML, Refshauge K, Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2015;67(11):15911603.

    • Search Google Scholar
    • Export Citation
  • 15

    Robertson D, Kumbhare D, Nolet P, Associations between low back pain and depression and somatization in a Canadian emerging adult population. J Can Chiropr Assoc. 2017;61(2):96105.

    • Search Google Scholar
    • Export Citation
  • 16

    Kalakoti P, Sciubba DM, Pugely AJ, Impact of psychiatric comorbidities on short-term outcomes following intervention for lumbar degenerative disc disease. Spine (Phila Pa 1976). 2018;43(19):13631371.

    • Search Google Scholar
    • Export Citation
  • 17

    Zakaria HM, Mansour TR, Telemi E, Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine. 2019;31(6):794801.

    • Search Google Scholar
    • Export Citation
  • 18

    Carreon LY, Djurasovic M, Dimar JR II, Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? J Neurosurg Spine. 2016;25(3):352356.

    • Search Google Scholar
    • Export Citation
  • 19

    Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271273.

    • Search Google Scholar
    • Export Citation
  • 20

    Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):29402952.

  • 21

    EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199208.

  • 22

    Stratford PW, Binkley JM, Riddle DL, Guyatt GH. Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part 1. Phys Ther. 1998;78(11):11861196.

    • Search Google Scholar
    • Export Citation
  • 23

    McCaffery M, Beebe A. Pain: A Clinical Manual for Nursing Practice. VV Mosby Co; 1993.

  • 24

    Adogwa O, Carr K, Fatemi P, Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976). 2014;39(19):16141619.

    • Search Google Scholar
    • Export Citation
  • 25

    Beaton DE. Simple as possible? Or too simple? Possible limits to the universality of the one half standard deviation. Med Care. 2003;41(5):593596.

    • Search Google Scholar
    • Export Citation
  • 26

    Copay AG, Glassman SD, Subach BR, Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Search Google Scholar
    • Export Citation
  • 27

    Hays RD, Woolley JM. The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Pharmacoeconomics. 2000;18(5):419423.

    • Search Google Scholar
    • Export Citation
  • 28

    Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407415.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 501 501 501
Full Text Views 64 64 64
PDF Downloads 31 31 31
EPUB Downloads 0 0 0