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Risk Factors for Postoperative Non-Satisfaction Despite ODI Improvement in Patients Undergoing Elective Lumbar
Jan Hambrecht1, Paul Köhli1,2, Erika Chiapparelli1
1Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
Study Design:
Secondary analysis of the prospective study.
Objective:
To assess the risk factors for postoperative non-satisfaction despite improvement in the Oswestry Disability Index (ODI) two years after elective lumbar surgery.
Background:
The ODI and postoperative satisfaction are important markers of postoperative success. Although ODI improvement is expected to correlate with satisfaction, their exact relationship remains unclear. In addition, some patients may achieve functional improvement yet report non-satisfaction postoperatively.
Methods:
A secondary analysis was performed on a prospective study of patients undergoing lumbar surgery for degenerative conditions. Patients with a two-year ODI and satisfaction follow-up were included. Risk factors for non-satisfaction despite ODI improvement were investigated using t tests, Wilcoxon-tests, and Fisher exact tests. Significant variables were analyzed with multivariable logistic regression, adjusting for covariates.
Results:
Three hundred fifty-five patients (65±10 y, 58% female) were included. Non-satisfied patients showed significantly higher scores in preoperative [64 (52-76), P <0.001] and postoperative [36 (20-44), P <0.001] ODI and lower absolute [18 (8-30), P <0.001] and percentage [30 (17-52), P <0.001] improvement rates from preoperatively to postoperatively. Higher baseline (OR 1.03, 95% CI 1.01-1.05, P <0.001) and postoperative (OR 1.08, 95% CI 1.06-1.10, P <0.001) ODI scores, and lower absolute (OR 0.94, 95% CI 0.92-0.96, P <0.001) and percentage (OR 0.95, 95% CI 0.94-0.97, P <0.001) improvement rates, were significant risk factors for experiencing non-satisfaction, despite ODI improvement. Higher fat infiltration (FI) of the multifidus (MF) (OR 1.03, 95% CI 1.00-1.06, P =0.042) or the erector spinae (ES) (OR 1.06, 95% CI 1.03-1.09, P <0.001) were significantly correlated with postoperative non-satisfaction, after adjusting for covariates.
Conclusion:
Higher preoperative and postoperative ODI scores and lower ODI improvement were linked to postoperative non-satisfaction. Higher FI in the MF or ES was also a significant risk factor for postoperative non-satisfaction, despite ODI improvement. The findings highlight that postoperative satisfaction is influenced by various factors affected by ODI-measured disability. In addition, paraspinal muscle health greatly affects postoperative outcomes and should guide preoperative planning and postoperative care.
