Skip to main content

Advertisement

SpringerLink
Log in

Decisional regret following corrective adult spinal deformity surgery: a single institution study of incidence and risk factors

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

To assess the characteristics and risk factors for decisional regret following corrective adult spinal deformity (ASD) surgery at our hospital.

Methods

This is a retrospective cohort study of a single-surgeon ASD database. Adult patients (> 40 years) who underwent ASD surgery from May 2016 to December 2020 with minimum 2-year follow-up were included (posterior-only, ≥ 4 levels fused to the pelvis) (n = 120). Ottawa decision regret questionnaires, a validated and reliable 5-item Likert scale, were sent to patients postoperatively. Regret scores were defined as (1) low regret: 0–39 (2) medium to high regret: 40–100. Risk factors for medium or high decisional regret were identified using multivariate models.

Results

Ninety patients were successfully contacted and 77 patients consented to participate. Nonparticipants were older, had a higher incidence of anxiety, and higher ASA class. There were 7 patients that reported medium or high decisional regret (9%). Ninety percentage of patients believed that surgery was the right decision, 86% believed that surgery was a wise choice, and 87% would do it again. 8% of patients regretted the surgery and 14% believed that surgery did them harm. 88% of patients felt better after surgery. On multivariate analysis, revision fusion surgery was independently associated with an increased risk of medium or high decisional regret (adjusted odds ratio: 6.000, 95% confidence interval: 1.074–33.534, p = 0.041).

Conclusions

At our institution, we found a 9% incidence of decisional regret. Revision fusion was associated with increased decisional regret. Estimates for decisional regret should be based on single-institution experiences given differences in patient populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Deidentified data is available upon request.

References

  1. Bess S et al (2016) The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976) 41(3):224–233

    Article  PubMed  Google Scholar 

  2. Carreon LY et al (2019) Cost-effectiveness of operative versus nonoperative treatment of adult symptomatic lumbar scoliosis an intent-to-treat analysis at 5-year follow-up. Spine (Phila Pa 1976) 44(21):1499–1506

    Article  PubMed  Google Scholar 

  3. Crawford CH et al (2015) The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 40(6):377–381

    Article  PubMed  Google Scholar 

  4. Smith JS et al (2021) Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events. J Neurosurg Spine 35:1–13

    Article  Google Scholar 

  5. Adogwa O et al (2018) Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity. J Neurosurg Spine 28(1):103–108

    Article  PubMed  Google Scholar 

  6. Adogwa O et al (2017) Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27(3):328–334

    Article  PubMed  Google Scholar 

  7. De la Garza Ramos R et al (2017) Timing of complications occurring within 30 days after adult spinal deformity surgery. Spine Deform 5(2):145–150

    Article  PubMed  Google Scholar 

  8. Kuo CC et al (2022) Vertebral bone quality score independently predicts proximal junctional kyphosis and/or failure after adult spinal deformity surgery. Neurosurgery 92:945

    Article  PubMed  Google Scholar 

  9. Bowen E et al (2020) Do decision aids benefit patients with chronic musculoskeletal pain? A systematic review. Pain Med 21(5):951–969

    Article  PubMed  Google Scholar 

  10. Boyd C et al (2019) Decision making for older adults with multiple chronic conditions: executive summary for the American geriatrics society guiding principles on the care of older adults with multimorbidity. J Am Geriatr Soc 67(4):665–673

    Article  PubMed  Google Scholar 

  11. Naik AD et al (2018) Development of a clinically feasible process for identifying individual health priorities. J Am Geriatr Soc 66(10):1872–1879

    Article  PubMed  PubMed Central  Google Scholar 

  12. Adogwa O et al (2022) Decisional regret among older adults undergoing corrective surgery for adult spinal deformity: a single institutional study. Spine (Phila Pa 1976) 47(8):E337–E346

    Article  PubMed  Google Scholar 

  13. Harris PA et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  14. Harris PA et al (2019) The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 95:103208

    Article  PubMed  PubMed Central  Google Scholar 

  15. Boland L et al (2019) Evaluation of a shared decision making educational program: the Ottawa decision support tutorial. Patient Educ Couns 102(2):324–331

    Article  PubMed  Google Scholar 

  16. O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Making 15(1):25–30

    Article  CAS  PubMed  Google Scholar 

  17. de Jesus C, Stacey D, Dervin GF (2017) Evaluation of a patient decision aid for unicompartmental or total knee arthroplasty for medial knee osteoarthritis. J Arthroplasty 32(11):3340–3344

    Article  PubMed  Google Scholar 

  18. ASA physical status classification system (2014) American society of anesthesiologists

  19. Iyer S et al (2018) Sagittal spinal alignment in adult spinal deformity: an overview of current concepts and a critical analysis review. JBJS Rev 6(5):e2

    Article  PubMed  Google Scholar 

  20. Banno T et al (2016) T1 pelvic angle is a useful parameter for postoperative evaluation in adult spinal deformity patients. Spine (Phila Pa 1976) 41(21):1641–1648

    Article  PubMed  Google Scholar 

  21. Hughes TM et al (2018) Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg 216(1):7–12

    Article  PubMed  Google Scholar 

  22. Hoffmann TC, Del Mar C (2015) Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med 175(2):274–286

    Article  PubMed  Google Scholar 

  23. Hoffmann TC, Del Mar C (2017) Clinicians’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med 177(3):407–419

    Article  PubMed  Google Scholar 

  24. Hadizadeh-Talasaz F et al (2021) Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial. BMC Pregnancy Childbirth 21(1):144

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bansback N et al (2019) An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 20(1):89

    Article  PubMed  PubMed Central  Google Scholar 

  26. Amara D et al (2019) Treatment of only the fractional curve for radiculopathy in adult scoliosis: comparison to lower thoracic and upper thoracic fusions. J Neurosurg Spine 30:1–9

    Article  Google Scholar 

  27. Becerra Pérez MM et al (2016) Extent and predictors of decision regret about health care decisions: a systematic review. Med Decis Making 36(6):777–790

    Article  PubMed  Google Scholar 

  28. Lonner B et al (2020) The patient generated index and decision regret in adolescent idiopathic scoliosis. Spine Deform 8(6):1231–1238

    Article  PubMed  Google Scholar 

  29. Cassidy RS et al (2023) Decision regret after primary hip and knee replacement surgery. J Orthop Sci 28(1):167–172

    Article  PubMed  Google Scholar 

  30. McIlvennan CK et al (2020) Perceived stress and depressive symptoms as predictors of decisional conflict in dyads considering a left ventricular assist device. Circ Cardiovasc Qual Outcomes 13(3):e006155

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lane GI et al (2022) Factors associated with decision aid use in localized prostate cancer. Urol Pract 9(1):108–115

    Article  PubMed  PubMed Central  Google Scholar 

  32. Advani PG et al (2019) Local therapy decisional regret in older women with breast cancer: a population-based study. Int J Radiat Oncol Biol Phys 104(2):383–391

    Article  PubMed  PubMed Central  Google Scholar 

  33. Boody BS et al (2017) Iatrogenic flatback and flatback syndrome: evaluation, management, and prevention. Clin Spine Surg 30(4):142–149

    Article  PubMed  Google Scholar 

  34. Ritzman TF, Floccari LV (2022) The sagittal plane in spinal fusion for adolescent idiopathic scoliosis. J Am Acad Orthop Surg 30(14):e957–e967

    Article  PubMed  Google Scholar 

  35. Baber Z, Erdek MA (2016) Failed back surgery syndrome: current perspectives. J Pain Res 9:979–987

    Article  PubMed  PubMed Central  Google Scholar 

  36. Arts MP et al (2012) Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients. Acta Neurochir (Wien) 154(7):1213–1217

    Article  PubMed  Google Scholar 

  37. Pesenti S et al (2018) The amount of proximal lumbar lordosis is related to pelvic incidence. Clin Orthop Relat Res 476(8):1603–1611

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lau D et al (2021) Multilevel pedicle subtraction osteotomy for correction of severe rigid adult spinal deformities: a case series, indications, considerations, and literature review. Oper Neurosurg (Hagerstown) 20(4):343–354

    Article  PubMed  Google Scholar 

  39. Sequeira SB et al (2022) Treatment decision regret in patients who develop periprosthetic joint infection and require two-stage revision surgery. J Arthroplasty 37(6S):S291–S296

    Article  PubMed  Google Scholar 

  40. Soroceanu A et al (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 41(22):1718–1723

    Article  PubMed  Google Scholar 

  41. Alshabab BS et al (2022) Evolution of proximal junctional kyphosis and proximal junctional failure rates over 10 years of enrollment in a prospective multicenter adult spinal deformity database. Spine (Phila Pa 1976) 47(13):922–930

    Article  PubMed  Google Scholar 

  42. Wick JB et al (2022) Assessment of adult spinal deformity complication timing and impact on 2-year outcomes using a comprehensive adult spinal deformity classification system. Spine (Phila Pa 1976) 47(6):445–454

    Article  PubMed  Google Scholar 

  43. Jayakumar P et al (2021) Comparison of an artificial intelligence-enabled patient decision aid vs educational material on decision quality, shared decision-making, patient experience, and functional outcomes in adults with knee osteoarthritis: a randomized clinical trial. JAMA Netw Open 4(2):e2037107

    Article  PubMed  PubMed Central  Google Scholar 

  44. Smith JS et al (2015) Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up. J Neurosurg Spine 23(3):349–359

    Article  PubMed  Google Scholar 

  45. Kim HJ et al (2022) Adult spinal deformity: a comprehensive review of current advances and future directions. Asian Spine J 16(5):776–788

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

There were no sources of external funding for this manuscript.

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, New York City, NY, 535 E 70th St.10021, USA

    Jerry Y. Du, Francis C. Lovecchio, Gregory Kazarian, John Clohisy, Anthony Pajak, Austin Kaidi, Rachel Knopp, Izzet Akosman, Mitchell Johnson, Hiroyuki Nakarai, Alexander Dash, Justin T. Samuel, Matthew E. Cunningham & Han Jo Kim

Authors
  1. Jerry Y. Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francis C. Lovecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory Kazarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Clohisy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anthony Pajak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Austin Kaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rachel Knopp
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Izzet Akosman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mitchell Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroyuki Nakarai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alexander Dash
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Justin T. Samuel
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Matthew E. Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Han Jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JD: Data analysis, draft, approved version, agrees to accountability for all aspects of this work; FL: Data Analysis, revised, approved version, agrees to accountability for all aspects of this work; GK: Data acquisition, revised, approved version, agrees to accountability for all aspects of this work; JC: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; AP: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; AK: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; RK: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; IA: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; MJ: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; HN: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; AD: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; JS: data acquisition, revised, approved version, agrees to accountability for all aspects of this work; MC: project conception, interpretation of data, revised, approved version, agrees to accountability for all aspects of this work; HJK: project conception, interpretation of data, revised, approved version, agrees to accountability for all aspects of this work.

Corresponding author

Correspondence to Jerry Y. Du.

Ethics declarations

Conflict of interest

There were no direct conflicts of interest in this manuscript. Jerry Du, Francis Lovecchio, Gregory Kazarian, John Clohisy, Anthony Pajak, Austin Kaidi, Rachel Knopp, Izzet Akosman, Mitchell Johnson, Hiroyuki Nakarai, Alexander Dash, and Justin Samuel have no disclosures. Matthew Cunningham: K2M – honoraria, Radius Health – money to institution, Better PT – board of directors, Sustain Surgical – Ownership Interest. Han Jo Kim: ISSG – money to institution, Acuity Surgical – honoraria, Zimmer Biomet – honoraria, K2M/ Stryker – honoraria, Nuvasive – consulting fees, Vivex Biology – monetary compensation, Aspen Medical – monetary compensation, AO Spine – money to institution.

Ethical approval

This study was approved by our Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 49 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Du, J.Y., Lovecchio, F.C., Kazarian, G. et al. Decisional regret following corrective adult spinal deformity surgery: a single institution study of incidence and risk factors. Spine Deform 12, 775–783 (2024). https://doi.org/10.1007/s43390-023-00790-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-023-00790-y

Keywords

Search

Navigation