Patient Predictors of Surgical Candidacy in Elective Spine Disorders

The expansion of age-related degenerative spine pathologies has led to increased referrals to spine surgeons. However, the majority of patients referred for surgical consultation do not need surgery, leading to inefficient use of healthcare resources. This study aims to elucidate preoperative patien...

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Bibliographic Details
Published in:Canadian journal of neurological sciences 2019-01, Vol.46 (1), p.96-101
Main Authors: Yang, Michael M.H., St-Pierre, Godefroy Hardy, DuPlessis, Stephan
Format: Article
Language:English
Subjects:
Adult
Aged
Body mass index
Cohort Studies
Comorbidity
Demographics
Elective Surgical Procedures - methods
Electromyography
Female
Humans
Logistic Models
Male
Medical referrals
Middle Aged
Narcotics
Neurosurgery
Original Article
Pain
Pain - diagnosis
Pathology
Patient Selection
Patients
Preoperative Care - methods
Primary care
Quality of Life
Questionnaires
Regression analysis
Spinal Diseases - surgery
Surgeons
Surgery
Surveys and Questionnaires
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Summary:The expansion of age-related degenerative spine pathologies has led to increased referrals to spine surgeons. However, the majority of patients referred for surgical consultation do not need surgery, leading to inefficient use of healthcare resources. This study aims to elucidate preoperative patient variables that are predictive of patients being offered spine surgery. We conducted an observational cohort study on patients referred to our institution between May 2013 and January 2015. Patients completed a detailed preclinic questionnaire on items such as history of presenting illness, quality-of-life questionnaires, and past medical history. The primary end point was whether surgery was offered. A multivariable logistical regression using the random forest method was used to determine the odds of being offered surgery based on preoperative patient variables. An analysis of 1194 patients found that preoperative patient variables that reduced the odds of surgery being offered include mild pain (odds ratio [OR] 0.37, p=0.008), normal walking distance (OR 0.51, p=0.007), and normal sitting tolerance (OR 0.58, p=0.01). Factors that increased the odds of surgery include radiculopathy (OR 2.0, p=0.001), patient's belief that they should have surgery (OR 1.9, p=0.003), walking distance
ISSN:0317-1671
2057-0155
DOI:10.1017/cjn.2018.342