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

• Published in: Spine deformity 2024-05, Vol.12 (3), p.775-783
• Main Authors: Du, Jerry Y., Lovecchio, Francis C., Kazarian, Gregory, Clohisy, John, Pajak, Anthony, Kaidi, Austin, Knopp, Rachel, Akosman, Izzet, Johnson, Mitchell, Nakarai, Hiroyuki, Dash, Alexander, Samuel, Justin T., Cunningham, Matthew E., Kim, Han Jo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Case Series; Decision Making; Emotions; Female; Humans; Incidence; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Retrospective Studies; Risk Factors; Spinal Curvatures - psychology; Spinal Curvatures - surgery; Spinal Fusion - adverse effects; Spinal Fusion - psychology; Surveys and Questionnaires
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-023-00790-y

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.