| Popis: |
Background: To describe success and failure (S&F) after lumbar spine surgery in terms that are preciseand that are equally understandable across the entire health ecosystem. Methods: Back and leg pain (NPRS scale) and disability (Oswestry Disability Index –ODI) of patients operated were prospectively recorded before and 6 to 12 months after the procedure. Satisfaction was recorded in the postoperative period. Initially, patients were classified as Satisfied or Unsatisfied.Optimal cutoff values for disability and pain were estimated with ROC curves. Satisfied and Unsatisfied groups were subdivided into four categories based on a combination of satisfaction, disability and pain: Success, Incomplete success, Incomplete failure and Failure. These categories were translated into operational definitions with simple verbal terms, according to previously described norms of numeric-to-verbal equivalence. Results: 486 consecutive patients were recruited from May 2019 to February 2021, with a drop-out rate of 16.4%; Preoperative PROMs mean values were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 (+ 2.9) points; 19.3% were classified as Unsatisfied and cutoff values for disability (ODI=28; AUC 0.79) and pain (NPRS=6; AUC 0.79) were defined. Satisfied and Unsatisfied groups were further subdivided based on concordance or non-concordance with the discrimination cutoff values: Success (59.6%) - satisfied with pain and disability levels concordant (NPRS ≤5, AND ODI ≤27); Incomplete success (20.4%) - satisfied with pain and disability levels non-concordant (NPRS ≥6 AND/OR ODI ≥28); Incomplete failure (7.1%) – unsatisfied with pain and disability levels non-concordant (NPRS ≤5 AND/OR ODI ≤27); and Failure (12.4%) - unsatisfied with pain and disability levels concordant (NPRS ≥6 AND ODI ≥28). After that, groups were translated to: Success - patients are satisfied and present no or only mild to tolerable pain, and no or borderline disability; Incomplete Success – patients are satisfied despite levels of pain and/or disability worse than the ideal for success; Incomplete Failure – patients are not satisfied despite levels of pain and/or disability better than expected for failure; Failure – patients are unsatisfied and present moderate to severe pain and disability.Conclusion: It is possible to report S&F after surgery for degenerative disc disease of the lumbar spine with precise and meaningful operational definitions focused on the experience of the patient. |
