Preoperative Symptom Duration Influences Perioperative Outcomes and Patient-Reported Outcomes After Surgical Treatment of Adult Spinal Deformity.

Abstract

Study designRetrospective study.ObjectiveThis study aimed to investigate the impact of symptom duration on patient-reported outcomes (PROs), satisfaction, and expectation fulfillment in elderly patients undergoing multi-level thoracolumbar fusion for adult spinal deformity (ASD).MethodsA retrospective cohort study was conducted on 237 ASD patients treated at our institution between July 2019 and July 2022. Patients were stratified based on symptom duration into three groups: Group A (6 months to ≤1 year), Group B (1 year to <2 years), and Group C (≥2 years). The study evaluated perioperative outcomes, PROs, achievement of minimal clinically important difference (MCID) for PROs-including the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D-5 L (EQ-5D-5 L)-as well as satisfaction and expectation fulfillment at 6-month, 1-year, and 2-year follow-ups. Multivariable regression analyses were performed to identify predictors of poor outcomes.ResultsA cohort of 237 patients met the inclusion criteria and were stratified into three groups based on symptom duration: 66 patients with ≤1 year of symptoms, 73 patients with 1 to <2 years, and 98 patients with ≥2 years. Comparative analyses revealed that patients with symptoms lasting ≥2 years had significantly longer hospital stays and higher complication rates compared to those with ≤1 year of symptoms. Additionally, this group was more likely to fail to achieve the MCID across multiple measures-including the ODI, EQ-5D-5 L, VAS-Leg, and VAS-Back-at the 2-years follow-up. Similar patterns were observed in satisfaction scores and expectation fulfillment rates. Multivariable regression, using the ≤1-year group as a reference, showed that patients in both the 1 to <2 years and ≥2 years groups had significantly higher odds of failing to achieve MCID for VAS-Leg, VAS-Back, ODI, and EQ-5D (<i>P</i> < 0.05). Furthermore, both longer-duration groups were significantly less likely to report satisfaction and fulfilled expectations at all follow-up points (6-month, 1-year, and 2-years) (<i>P</i> < 0.05).ConclusionsA symptom duration of ≥2 years was robustly associated with inferior PROs, reduced postoperative satisfaction, and lower fulfillment of expectations. These findings imply that prompt referral and surgical intervention for adult spinal deformity may play a pivotal role in optimizing patient outcomes.