Predictors of surgical outcome and their assessment

Mannion, Anne; Elfering, Achim (2006). Predictors of surgical outcome and their assessment. European spine journal, 15(Supplement 1), S93-S108. Berlin: Springer 10.1007/s00586-005-1045-9

Preview

Text Mannion-Elfering2005_Article_PredictorsOfSurgicalOutcomeAnd.pdf - Published Version Available under License Publisher holds Copyright. Download (625kB) | Preview

The relatively high rate of failed back surgery has prompted the search for “risk factors” to predict the result of spinal surgery in a given individual. However, the literature reveals few unequivocal predictors and they often explain a relatively low proportion of variance in outcome. This suggests that we have a long way to go before being able to rest easily, having refused someone surgery on the basis of unfavourable baseline characteristics. The best recommendation is to ensure, firstly, that the indication for surgery is absolutely clear-cut (i.e. that surgically remediable pathology exists) and then to consider the various factors that may influence the “typical” outcome. Consistent risk factors for a poor outcome regarding return-to-work include long-term sick leave/receipt of disability benefit. Hence, every effort should be made to keep the individual in the workforce, despite the ongoing symptoms and plans for surgery. In patients with a particularly heavy job, consultation with occupational physicians might later ease the patient’s way back into the workplace. Patients with degenerative disorders and/or comorbidity should be counselled that few of them will have complete/lasting pain relief or a complete return to pre-morbid function. Patients with a high level of distress may benefit from psychological treatment, before and/or accompanying the surgical treatment. The opportunity (time), encouragement (education and positive messages), and resources (referral to appropriate support services) to modify risk factors that are indeed modifiable should be offered, and realistic expectations should be discussed with the patient before the decision to operate is made.

Interest & Impact

Downloads

13 since deposited on 04 Oct 2013
13 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item