March 7, 2018 / 8:08 PM / 15 days ago

Website estimates odds of spine surgery success

Reuters Health - Doctors in Washington state have developed a website designed to help people with back and leg pain predict whether spinal fusion will help their symptoms.Spinal fusion is surgery that locks two or more bones along the back so they can no longer flex separately. The website, here, calculates the odds of success, such as the likelihood of having minimal disability one year after surgery.The calculations are based on the records of 1,965 adults seen in 15 Washington hospitals who were candidates for lumbar, or lower spine, surgery from 2012 through 2015.The website is designed to be used with a doctor, unless patients know technical details such as how they rank on the American Society of Anaesthesiologists physical status classification system and the technical term for the source of their pain."The best way to understand whether surgery is right for you is to have a better conversation with your doctor, and tools like this may be a key to getting that to happen," senior author Dr. David Flum told Reuters Health in a telephone interview.The website allows consumers to see how insurance type, their use of prescription opioid painkillers, and the decision to delay surgery might affect the likelihood of success.Oddly, the system doesn't allow older people to select Medicare as their insurance type because the program automatically adjusts for age. In that case, patients should select the "Other" option, said Dr. Flum, director of the Surgical Outcomes Research Center at the University of Washington in Seattle.Details of the project and an analysis of overall success rates appear in the journal JAMA Surgery.The Flum team found that 58.0% of people with moderate to severe symptoms reported improvements in function after surgery versus 43.8% of those who decided against surgery.Similarly, 68.5% with surgery reported improvements in back pain compared with 53.4% who decided to forego an operation. For leg pain, the 12-month improvement rate was 76.5% with surgery and 63.9% without."People without surgery get better too," said Dr. Flum.Their results illustrate the importance of things such as smoking status and whether a person with back or leg pain is on Medicaid, the state-run health insurance plan for the poor financed largely by federal dollars.For example, a 45-year-old man with private insurance might have a 51% chance of minimal disability a year after surgery if he has never smoked, but that success rate plummets to 26% if he's a smoker.Dr. Flum said that's why it's important for smokers to quit a few months before their surgery; just six months of abstinence can dramatically improve success rates because smoking hinders the body's ability to heal.The same nonsmoking patient has a success rate of just 20% if he is on Medicaid. That may have something to do with the stresses associated with being poor in America, which may affect a person's ability to heal or respond to treatment, the researcher speculated.Dr. Flum said work is continuing to try to make the calculations even more precise and identify additional factors that affect the success of surgery."There's an NIH study looking at things like social support, emotional support, work status and the use of cannabis that are going into a continual refinement of this calculator," he said. Duration of symptoms and the presence of anxiety or depression might also affect outcomes.Some people like to make decisions on treatment based on specific estimates of risks and benefits while "there are those who go with their gut," said Dr. Flum. "But everyone will benefit from a better conversation with their doctor, and that's what we're trying to get to." SOURCE: JAMA Surgery online, March 7, 2018.

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