Predictive factors for satisfaction with surgery following anterior posterior same day spinal fusion

Patient satisfaction is an important measure of quality of care following spine surgery. Same-day anterior posterior circumferential spine surgery is a reliable technique used to achieve a successful lumbar arthrodesis. The purpose of this study is to identify predictive factors for 6-month patient satisfaction following 1-2 level same-day anterior and posterior spinal fusion.

Adult patients undergoing 1-2 level anterior posterior fusion (APF) from 2018 to 2022 were identified from a single surgeon database. Patients undergoing APF were divided into two cohorts: (I) patients satisfied at 6 months; (II) patients not satisfied at 6 months. Pre-operative, intra-operative, perioperative, 6-week, and 6-month variables were assessed. Univariate, bivariate, and multivariable regression were performed. Threshold regression analysis was utilized to determine thresholds for continuous variables when significant on bivariate analysis.

A total of 97 consecutive patients who underwent 1-2 level anterior-posterior same-day lumbar fusion surgery were identified. Of these, 79 patients (81%) were satisfied at 6 months. The average age of all patients was 51 years [standard deviation (SD) 11 years]; 46 patients (47%) were female, 60 (62%) used opiates, and 7 (7%) had undergone prior laminectomy surgery. Bivariate analysis showed satisfied patients were less likely to be prior opiate users (57% vs. 83%; P=0.04), less likely to have had prior laminectomy (4% vs. 22%; P=0.006), and less likely to have postoperative day 1 (POD1) mobility <200 feet (63% vs. 89%; P=0.04). Satisfied patients were more likely to have higher POD1 mobility (197 vs. 54 ft; P=0.007), a lower visual analog scale (VAS) score (4.79 vs. 8; P<0.001), a VAS score <5 at week 6 (61% vs. 6%; P<0.001), be satisfied at week 6 (94% vs. 50%; P<0.001), and experience a larger drop in VAS score by week 6 (-3.13 vs. +0.17; P<0.001). By month 6, satisfied patients had a lower VAS score and experienced a greater drop in VAS score (-4 vs. -1; P<0.001). Multivariable analysis showed no prior laminectomy [odds ratio (OR) 0.04; 95% confidence interval (CI): 0.00-0.41; P=0.01], VAS <5 at week 6 (OR 17.4; 95% CI: 1.91-158; P=0.01), satisfaction at week 6 (OR 11.59; 95% CI: 1.78-75.43; P=0.01), and no preoperative opiate use (OR 13.86; 95% CI: 1.33-143; P=0.03) were associated with increased odds of patient satisfaction at 6 months postoperatively.

Multivariable analysis identified week 6 satisfaction, VAS <5, no prior laminectomy, and no preoperative opiate use as independent predictors for 6-month satisfaction following anterior-posterior same-day spinal fusion surgery. These findings can help counsel patients and manage their expectations preoperatively, perioperatively, and during the 6-week visit.