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Health-Related Quality of Life Scores Underestimate the Impact of Major Complications in Lumbar Degenerative Scoliosis Surgery

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Abstract

Study Design

Retrospective cohort.

Objective

To examine Charlson Comorbidity Index (CCMI) as a marker for deterioration in health status not reflected in standard Health Related Quality of Life (HRQOL) measures.

Summary of Background Data

HRQOL has become a primary metric for assessing outcomes following spinal deformity surgery. However, studies have reported limited impact of complications on postoperative HRQOL outcomes.

Methods

We examined serial CCMI, complications, and HRQOL outcomes for 138 adult lumbar deformity patients treated surgically with a minimum two-year follow-up that included 126 females (91%) with a mean age of 59.8 years (range, 40.2–78.5). Patients with no, minor, or major complications were compared at baseline and at one and two years postoperation.

Results

Minor complications were observed in 26 patients (19%) and major complications in 15 (11%). Major complications included motor deficit (7), deep vein thrombosis (4), and respiratory failure (3). There was no difference in preoperative SF-36 Physical Component Summary or Scoliosis Research Society—22R (SRS-22R) scores among the groups at baseline. Preoperative CCMI was lowest in the No Complication group (3.52 ± 1.70) followed by the Major (4.00 ± 1.13) and Minor Complication groups (4.15 ± 1.71, p = .165). At one year, there was a significantly greater CCMI deterioration in the Major Complication group (0.80 ± 1.01) compared to both the Minor (0.08 ± 0.27) and No Complication groups (0.27 ± 0.47, p < .001). There was no significant difference in SF-36 Physical Component Summary or SRS-22R scores among the three groups. Similar findings were observed at two years.

Conclusions

Despite similar one- and two-year HRQOL improvement, patients with major complications had greater deterioration in CCMI. As CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including any subsequent spinal surgery. Although this increased risk may not alter the patient’s perception of his or her current health status, it may be important, and should be recognized as part of the shared decision-making process.

Level of Evidence

Level II, high-quality prognostic study.

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Author information

Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA

    Steven D. Glassman MD & Leah Y. Carreon MD, MSc

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO, 63110, USA

    Keith H. Bridwell MD & Christine R. Baldus MA

  3. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA, 22908, USA

    Christopher I. Shaffrey MD

  4. The Maryland Spine Center at Mercy Medical Center, 301 St. Paul Place, Baltimore, MD, 21202, USA

    Charles C. Edwards II MD

  5. Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA

    Jon D. Lurie MD, MS

Authors
  1. Steven D. Glassman MD
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  2. Keith H. Bridwell MD
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  3. Christopher I. Shaffrey MD
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  4. Charles C. Edwards II MD
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  5. Jon D. Lurie MD, MS
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  6. Christine R. Baldus MA
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  7. Leah Y. Carreon MD, MSc
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Corresponding author

Correspondence to Leah Y. Carreon MD, MSc.

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Author disclosures

SDG (grant to institution from the National Institutes of Health [NIH], employee of Norton Healthcare, patents issued for Medtronic, and royalties from Medtronic; other from NuVasive [NuVasive provides funds directly to database company; no funds are paid directly to the individual or the individual’s institution, June 2012–April 2015]); KHB (grant to institution from NIH, royalties from Wolters-Kluwer); CIS (grant to institution from NIH, Department of Defense, and International Spine Study Group; consultancy fees from Stryker and K2M; royalties from Biomet, Medtronic, and NuVasive; and fellowship support to institution from AOSpine and Neurosurgery Research & Education Foundation); CCE (grant to institution from NIH; royalties from Renovis; stock/stock options in Renovis and NEO); JDL (grant to institution from NIH; board membership fees from Spine, The Spine Journal, and ISRN Orthopaedics; consultancy fees from NewVert and FzioMed; and stock/stock options in NewVert); CRB (grant to institution from NIH); LYC (grant to institution from NIH, Orthopedic Research and Educational Fund [research funding for Minimize Implants Maximize Outcomes RCT, 2013—current], and Scoliosis Research Society [research funding for study “Evidence-Based Algorithm for the Surgical Treatment of Lumbosacral Spondylolisthesis,” current]; institutional review board member of the University of Louisville Institutional review Board; research committee member of the Scoliosis Research Society; consultancy fees from Washington University at St. Louis and AOSpine; employee from Norton Healthcare; travel expenses from University of Louisville Institutional Review Board [Annual required Continuing Education for Institutional Review Board Members], Association for Collaborative Spine Research [Travel and accommodations for Study Planning Meetings, June 2012, February 2014, and June 2014], Center for Spine Surgery and Research, Region of Southern Denmark [Travel and accommodations for Study Planning Meetings, October 2013, May 2014, September 2014, December 2014, May 2015, August 2015, April 2016, August 2016, December 2016]; and other from NuVasive [NuVasive provides funds directly to database company; no funds are paid directly to the individual or the individual’s institution, June 2012–April 2015]).

This study was reviewed and approved by the University of Louisville Institutional Review Board.

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Glassman, S.D., Bridwell, K.H., Shaffrey, C.I. et al. Health-Related Quality of Life Scores Underestimate the Impact of Major Complications in Lumbar Degenerative Scoliosis Surgery. Spine Deform 6, 67–71 (2018). https://doi.org/10.1016/j.jspd.2017.05.003

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  • DOI: https://doi.org/10.1016/j.jspd.2017.05.003

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