Factors Associated with the Decision to Undergo Spine Surgery: The Role of Self-Efficacy, Pain Tolerance, & Resilience.

Abstract

Prospective Cohort Study. The purpose of this prospective study is to compare demographic, psychosocial, and lifestyle factors between patients who chose to undergo spine surgery and those who did not. The decision to undergo spine surgery is both complex and multifaceted, as it is influenced by a combination of clinical and psychological symptom management behaviors. Specifically, psychosocial metrics, such as resilience and pain self-efficacy, have demonstrated important relationships between spine surgery outcomes. Adult patients at a single academic institution from 2020-2022 who were seeking consultation from a spine surgeon were administered questionnaires during their visit which included the Brief Resilience Scale (BRS), 2-question Pain Self-Efficacy Questionnaire (PSEQ. 2), and a pain tolerance question. Baseline demographic, social, and clinical metrics were recorded. Patients were followed for a mean of 44 months. Individuals who underwent surgery were assigned to the operative group (OP) and those who did were assigned to the nonoperative group (NONOP). 269 patients had full survey data and were included. 85 in the OP group and 184 in the NONOP group. Significant differences between the groups were observed in age (OP: 65.0 y vs. NONOP: 59.4 y, P=0.0112) and time of consult Visual Analog Scale (VAS) pain scores (OP: 6.57 vs. NONOP: 5.13, P<0.001). The NONOP group reported higher pain self-efficacy scores (PSEQ. 2) compared to the OP group (7.11 vs. 5.69, P=0.00108). Regression analysis adjusting for VAS pain scores showed higher PSEQ. 2 was independently associated with remaining nonoperative (OR=0.917; 95% CI[0.841, 0.997]). Higher pain self-efficacy, independent of pain level, was associated with a lower likelihood of undergoing spine surgery, suggesting that a patient's perception of their ability to manage their symptoms factors into the choice to undergo surgery. These findings highlight the importance of psychosocial factors, such as pain self-efficacy, in surgical decision-making and may inform patient counseling strategies.