Patient-oriented outcomes from low back surgery: A community-based study

Victoria M. Taylor, Richard (Rick) Deyo, Marcia Ciol, Edward L. Farrar, Michael S. Lawrence, Neal H. Shonnard, K. Mark Leek, Brad McNeney, Harold I. Goldberg

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Study Design. This study used a prospective cohort design. Objective: To examine factors associated with favorable self-reported patient outcomes 1 year after elective surgery for degenerative back problems. Summary of Background Data. Many previous studies addressing the results of low back surgery have been conducted in academic institutions or by single surgeons. As part of a quality improvement effort, surgeons in private practice led a community-based outcomes management project in Washington State. Methods. Patients ages 18 and older with the following diagnoses were eligible for the study: degenerative changes, herniated disc, instability, and spinal stenosis. Nine orthopedists and neurosurgeons enrolled a total of 281 patients. Participants were asked to complete baseline and 1-year follow-up surveys. Data concerning diagnoses, clinical signs, and operative procedures were provided by the surgeons. The researchers examined sociodemographic characteristics, self-reported symptoms before surgery, preoperative clinical signs, diagnoses, and operative procedures associated with three primary outcomes: better functioning, improved quality of life, and overall treatment satisfaction. Results. Follow-up surveys were completed by 236 (84%) of the enrolled patients. Approximately two thirds of the study participants reported much better functioning (65%), a great quality of life improvement (64%), and a very positive perspective about their treatment outcome (68%). The following variables were associated with worse patient outcomes: older age, previous low back surgery, workers' compensation coverage, and consultation with an attorney before surgery. Patients undergoing a fusion procedure were more likely to report good outcomes. Conclusions. The authors' experience indicates that community-based outcomes data collection efforts are feasible and can be incorporated into usual clinical practice. The study results indicate that compensation payments and litigation are two important predictors of poor outcomes after low back surgery in community practice. Because of small numbers, varied diagnoses, and possible selection bias, the findings with respect to fusion should be interpreted cautiously.

Original languageEnglish (US)
Pages (from-to)2445-2452
Number of pages8
JournalSpine
Volume25
Issue number19
DOIs
StatePublished - Oct 1 2000
Externally publishedYes

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Operative Surgical Procedures
Quality Improvement
Quality of Life
Workers' Compensation
Spinal Stenosis
Intervertebral Disc Displacement
Lawyers
Selection Bias
Private Practice
Jurisprudence
Compensation and Redress
Referral and Consultation
Research Personnel
Surgeons
Surveys and Questionnaires
Therapeutics
Patient Reported Outcome Measures
Orthopedic Surgeons
Neurosurgeons

Keywords

  • Low back surgery
  • Patient outcomes

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Taylor, V. M., Deyo, R. R., Ciol, M., Farrar, E. L., Lawrence, M. S., Shonnard, N. H., ... Goldberg, H. I. (2000). Patient-oriented outcomes from low back surgery: A community-based study. Spine, 25(19), 2445-2452. https://doi.org/10.1097/00007632-200010010-00005

Patient-oriented outcomes from low back surgery : A community-based study. / Taylor, Victoria M.; Deyo, Richard (Rick); Ciol, Marcia; Farrar, Edward L.; Lawrence, Michael S.; Shonnard, Neal H.; Leek, K. Mark; McNeney, Brad; Goldberg, Harold I.

In: Spine, Vol. 25, No. 19, 01.10.2000, p. 2445-2452.

Research output: Contribution to journalArticle

Taylor, VM, Deyo, RR, Ciol, M, Farrar, EL, Lawrence, MS, Shonnard, NH, Leek, KM, McNeney, B & Goldberg, HI 2000, 'Patient-oriented outcomes from low back surgery: A community-based study', Spine, vol. 25, no. 19, pp. 2445-2452. https://doi.org/10.1097/00007632-200010010-00005
Taylor VM, Deyo RR, Ciol M, Farrar EL, Lawrence MS, Shonnard NH et al. Patient-oriented outcomes from low back surgery: A community-based study. Spine. 2000 Oct 1;25(19):2445-2452. https://doi.org/10.1097/00007632-200010010-00005
Taylor, Victoria M. ; Deyo, Richard (Rick) ; Ciol, Marcia ; Farrar, Edward L. ; Lawrence, Michael S. ; Shonnard, Neal H. ; Leek, K. Mark ; McNeney, Brad ; Goldberg, Harold I. / Patient-oriented outcomes from low back surgery : A community-based study. In: Spine. 2000 ; Vol. 25, No. 19. pp. 2445-2452.
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abstract = "Study Design. This study used a prospective cohort design. Objective: To examine factors associated with favorable self-reported patient outcomes 1 year after elective surgery for degenerative back problems. Summary of Background Data. Many previous studies addressing the results of low back surgery have been conducted in academic institutions or by single surgeons. As part of a quality improvement effort, surgeons in private practice led a community-based outcomes management project in Washington State. Methods. Patients ages 18 and older with the following diagnoses were eligible for the study: degenerative changes, herniated disc, instability, and spinal stenosis. Nine orthopedists and neurosurgeons enrolled a total of 281 patients. Participants were asked to complete baseline and 1-year follow-up surveys. Data concerning diagnoses, clinical signs, and operative procedures were provided by the surgeons. The researchers examined sociodemographic characteristics, self-reported symptoms before surgery, preoperative clinical signs, diagnoses, and operative procedures associated with three primary outcomes: better functioning, improved quality of life, and overall treatment satisfaction. Results. Follow-up surveys were completed by 236 (84{\%}) of the enrolled patients. Approximately two thirds of the study participants reported much better functioning (65{\%}), a great quality of life improvement (64{\%}), and a very positive perspective about their treatment outcome (68{\%}). The following variables were associated with worse patient outcomes: older age, previous low back surgery, workers' compensation coverage, and consultation with an attorney before surgery. Patients undergoing a fusion procedure were more likely to report good outcomes. Conclusions. The authors' experience indicates that community-based outcomes data collection efforts are feasible and can be incorporated into usual clinical practice. The study results indicate that compensation payments and litigation are two important predictors of poor outcomes after low back surgery in community practice. Because of small numbers, varied diagnoses, and possible selection bias, the findings with respect to fusion should be interpreted cautiously.",
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