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• W4386041768 abstract "In addition to surgical factors, repeat (ie, subsequent) lumbar surgery after a first (ie, index) surgery may be associated with comorbidity and psychosocial factors. Among patients undergoing a first lumbar surgery, to ascertain the incidence of a subsequence surgery and to identify factors associated with repeat surgery; also, to compare characteristics of subsequent surgery according to whether it occurred earlier (<18 months) vs later (≥18 months) after the first surgery. Prospective cohort studies with 2-year patient follow-up and additional monitoring of hospital records up to 13 years. A total of 992 patients undergoing a first lumbar surgery for diverse diagnosis. Incidence and time to subsequent surgery. Pre- and postop data from 3 studies assessing patients’ expectations of outcome were pooled to ascertain occurrence and characteristics of subsequent surgery. Data from the first surgery included diagnosis, number of abnormal vertebrae on imaging, number of levels operated on, complexity of surgery according to the Surgical Invasiveness Index (SII, measuring decompression, fusion, instrumentation), ODI scores, depressive symptoms, patients’ expectations of surgery, opioid use, and comorbidity. Information about subsequent surgery was obtained from patient interviews 2-years postop and from hospital records up to 13-years postop. Data from the subsequent surgery included reason for repeat surgery, procedure performed, and vertebrae involved according to whether surgery occurred earlier (<18 months) or later (≥18 months). Fulfillment of expectations was measured at the 2-year follow-up with a validated survey. Mean age was 60, first surgery diagnosis was 36% stenosis, 29% spondylolisthesis, 16% herniated disc, 7% degenerative disc, and 6% scoliosis. 153 patients (15%) had subsequent surgery a mean of 3.0 years later (range 1 week – 12.2 years). Variables present at the first surgery that were associated with subsequent surgery were more depressive symptoms, more medical comorbidity, taking opioids, surgery to more levels, and disease present at nonoperated levels on imaging (all p≤.06, bivariate analyses). In multivariable analysis the following variables from the first surgery remained associated: depressive symptoms (OR 1.5, CI 1.0-2.2), comorbidity (OR 1.5, CI 1.0-2.1), surgery to ≥3 levels (OR 2.0, CI 1.3-3.2), and disease present at nonoperated levels on imaging (OR 1.9, CI 1.2-3.1) (all p≤.05). Subsequent surgery may have been attributed to the first surgery in 31% (ie, pseudarthrosis 5%, adjacent segment 7%, junctional breakdown 7%, painful hardware 4%, fracture 3%, nonunion 5%, infection 3%). Compared to later subsequent surgery (≥18 months, 62%) earlier subsequent surgery (<18 months, 38%) was more likely to involve only the same index level(s) (19% vs 48%, p<.0001) and to be associated with more complex index surgery (SII 7 vs 11, p=.0008). Based on patients’ assessment of outcome, more patients with unfulfilled expectations underwent subsequent surgery earlier (45% vs 55%, p=.0008). In addition to surgical factors, psychosocial variables and medical comorbidity were associated with occurrence and timing of subsequent lumbar surgery. Surgeons should consider these variables when counselling patients about possible repeat lumbar surgery. This abstract does not discuss or include any applicable devices or drugs." @default.
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• W4386041768 date "2023-09-01" @default.
• W4386041768 modified "2023-10-09" @default.
• W4386041768 title "179. Psychosocial and nonsurgical medical variables impact occurrence of repeat lumbar surgery" @default.
• W4386041768 doi "https://doi.org/10.1016/j.spinee.2023.06.201" @default.
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