Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis |
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Authors: | Y. Raja Rampersaud MD FRCSC Eugene K. Wai MD MSc CIP FRCSC Charles G. Fisher MD MHSc FRCSC Albert J.M. Yee MD FRCSC Marcel F.S. Dvorak MD FRCSC Joel A. Finkelstein MD FRCSC Rajiv Gandhi MS MD FRCSC Edward P. Abraham MD FRCSC Stephen J. Lewis MD MSC FRCS David I. Alexander MD FRCSC William M. Oxner MD FRCSC J.R. Davey MD FRCSC Nizar Mahomed MD ScD FRCS |
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Affiliation: | aDivision of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, University Health Network, 399 Bathurst St, East Wing 1-441, Toronto, Ontario, Canada M5T-2S8;bSpinal Program, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, Ontario, Canada M5T-2S8;cDivision of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling, Ottawa, Ontario, Canada K1Y 4E9;dClinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, Ontario, Canada K1Y 4E9;eCombined Neurosurgical and Orthopaedic Spine Program (CNOSP), Department of Orthopaedics, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver General Hospital, 2647 Willow St, Vancouver, British Columbia, Canada V5Z 3P1;fSunnybrook Health Sciences Center, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5;gAtlantic Health Science Corporation, St. John, New Brunswick, Canada;hDalhousie University, QEII Health Sciences Center, 1796 Summer St, Halifax, Nova Scotia, Canada B3H 3A7 |
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Abstract: | Background contextThe results of single-center studies have shown that surgical intervention for lumbar spinal stenosis yielded comparable health-related quality of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these results are generalizable to routine clinical practice in Canada is unknown.PurposeThe primary purpose of this equivalence study was to compare the relative improvement in physical HRQoL after surgery for focal lumbar spinal stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six Canadian centers.Study design/settingA Canadian multicenter ambispective cohort study.Patient sampleA cohort of 371 primary one- to two-level spinal decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip (n=156) and knee (n=208) arthroplasty for OA.Outcome measuresThe primary outcome was the change in preoperative to 2-year postoperative 36-Item Short Form Health Survey Physical Component Summary (PCS) score as reflected by the number of patients reaching minimal clinically important difference (MCID) and substantial clinical benefit (SCB).MethodsUnivariate analyses were conducted to identify baseline differences and factors that were significantly related to outcomes at 2 years. Multivariable regression modeling was used as our primary analysis to compare outcomes between groups.ResultsThe mean age (years) and percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, and 65.8/64.3, respectively. All three groups experienced significant improvement of baseline PCS (p<.001). Multivariate analyses, adjusting for baseline differences (age, gender, baseline Mental Component Summary score, baseline PCS), demonstrated no significant differences in PCS outcome between spinal surgery and arthroplasty (combined hip and knee cohorts) patients with an odds ratio of 0.80 (95% confidence interval [CI], 0.57–1.11; p=.17) and 0.79 (95% CI, 0.58–1.09; p=.15) for achieving MCID or SCB, respectively. In subgroup analysis, spine and knee outcomes were not significantly different, with hip arthroplasty superior to both (p<.0001).ConclusionsSignificant improvement in physical HRQoL after surgical treatment of FLSS (including DLS) is consistently achieved nationally. Our overall results demonstrate that a comparable number of patients can expect to achieve MCID and SCB 2 years after surgical intervention for FLSS and total knee arthroplasty. |
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Keywords: | Spinal stenosis Osteoarthritis Hip Knee Surgery Health-related quality of life |
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