A Standardized Perioperative Care Program and Postoperative Pain, Disability, and Knowledge Among Patients Undergoing...

Patients recovering from lumbar spine surgery frequently report persistent pain, functional limitation, and limited understanding of postoperative self-care. This study examined whether participation in a standardized perioperative care program was associated with differences in pain, functional disability, and patient knowledge at 2 months, compared with routine hospital care, among adults undergoing elective lumbar spine surgery in Erbil, Iraq.

This was a non-randomized (quasi-experimental) controlled study with two parallel groups and pre-post assessment, conducted between September 29, 2024 and April 25, 2025 in the Neurosurgery Unit of Hawler Teaching Hospital. Participants were recruited by purposive sampling and allocated non-randomly by admission cohort; groups were matched on surgery type and key sociodemographic characteristics. Reporting follows the TREND statement for non-randomized evaluations and the TIDieR checklist for intervention description. Outcomes were pain (Universal Pain Assessment Tool, 0-10), functional disability (Oswestry Disability Index, reported throughout on the 0%-100% scale), and knowledge (36-item researcher-developed questionnaire, scaled 0-100). The primary analysis was the between-group difference in change from baseline, estimated by analysis of covariance adjusted for the baseline outcome value and pre-specified covariates and confirmed by a linear mixed model. Responder, hierarchical-regression, and mediation analyses were pre-specified as exploratory and non-causal.

Seventy patients (35 per group) completed the study with no loss to follow-up. Groups were comparable at baseline (all p > 0.05). At 2 months, the intervention group reported lower pain (median 0 [IQR 0-2] vs. 5 [3-7]; p < 0.001), lower disability (ODI 4% [2-6] vs. 46% [30-68]; p < 0.001), and higher knowledge (69 [67-70] vs. 41 [40-46]; p < 0.001). The between-group differences in mean change from baseline favored the program for pain (- 3.58 points), disability (- 44.2 percentage points), and knowledge (+ 25.3 points). In exploratory hierarchical regression, program participation showed the largest standardized coefficient for treatment response (β = 0.58, p < 0.01), with the full model accounting for 69% of the variance; these estimates are associative and are not adjusted for unmeasured confounding.

Participation in an intensive, structured perioperative care program was associated with substantially better self-reported pain, disability, and knowledge at 2 months in this selected single-center cohort. Because allocation was not randomized and the program involved considerably greater professional contact than routine care, these findings describe an association rather than a causal effect, and require confirmation in randomized, multicentre trials with longer follow-up.

ClinicalTrials.gov (NCT07459985), registered 04/03/2026 (retrospectively registered; see Section 2.13).