PATIENT PRIORITIZATION FOR LUMBAR DECOMPRESSION BY PREOPERATIVE PATIENT-REPORTED OUTCOME MEASURES

Significant NHS waiting lists for Lumbar Spine Decompression necessitate further research to better prioritise patients. We aimed to investigate the association of pre-operative patient reported outcome measures (PROM) on the post-operative improvement following surgery. A retrospective cohort analysis on PROM data collected at Woodend General Hospital between January 2018 and June 2022. Excluding multilevel level decompression and revision surgery, all patients >16yrs undergoing lumbar decompression were included. Our primary outcomes were pre-operative, and 1yr post-operative, Oswestry Disability Index (ODI) and EQ-VAS questionnaires. Linear regression modelling on pre-operative ODI/EQVAS and the degree of improvement from pre-operative baseline at 1yr. This analysis was undertaken in R (version 4.4.1). A negative correlation of pre-operative ODI/EQ-VAS with the degree improvement at 1yr was found; with significant values for ODI and EQ-VAS of p = 0.0028 and p < 0.001, respectively. These findings can be used to identify patients likely to benefit most from surgery, as well as better counsel patients considering lumbar decompression surgery. Pre-operative ODI >22 and pre-operative EQ-VAS <60 inferred a significant (95% confidence interval) likelihood of an improvement at 1yr. Furthermore, assuming a minimally clinically important difference of 15% (ODI) and 7% (EQVAS), a clinically detectable difference is predicted for pre-operative scores > 43 ODI and >9 EQVAS. This study supports lumbar decompression surgery for patients with the most debilitating pre-operative PROMs. This study also suggests cut off values for pre-operative PROMs which can aid patient counselling and timing of surgery. Further studies are however required to further characterise this relationship.