The impacts of comorbid diseases on surgical and clinical outcomes in spondylolisthesis surgery

Year 2025, Volume: 8 Issue: 2, 167 - 173, 21.03.2025

Fahri Eryılmaz , Göker Yurdakul

https://doi.org/10.32322/jhsm.1604696

Abstract

Aims: Management of comorbidities has a significant bearing on clinical outcomes from surgery, especially in the context of wound healing and pain management. This study aims to compare surgical patients with comorbidity (case group) and without (control group) based on recovery outcomes.
Methods: Surgical patients n=150 were enrolled patients in the case group (n=75), and control group (n=75). We collected and compared baseline demographic data, preoperative and postoperative pain levels based on the Visual Analogue Scale, discharge outcomes and assessment of wound healing. Factors affecting wound healing were evaluated using multivariate logistic regression, and predictors of postoperative pain were examined with multivariate linear regression.
Results: Demographic data revealed that the groups were comparable regarding age (p=0.122) and gender (p=0.758). The case group did have a higher mean body-mass index (BMI) of 28.9±3.4 than the control group mean BMI, which was 25.7±2.9; (p<0.001). Preoperative 7.5±1.2 vs 6.8±1.1, (p=0.001) and postoperative 4.8±1.5 vs 3.2±10, (p<0.001), pain scores were significantly greater in the case group. This is especially true for the case group, as only 40% were discharged in less than or equal to 24 hours compared with 73.3% of control (p<0.001). Cure of all wounds occurred in 90.7% of controls compared with 66.7% of cases (p<0.001), and delayed healing was significantly greater in cases (33.3% vs 9.3%, p=0.002). The case group had an odds ratio of 0.25 (p<0.001) for complete wound healing on multivariate analysis whereas group status, age, BMI and diabetes mellitus were significant postoperative pain predictors.
Conclusion: These findings highlight the need to direct resources towards preoperative evaluations before spondylolisthesis surgery and strategies in recovery after surgery for patients with diseases/disorders relevant to common problems seen.

Keywords

Spondylolisthesis, comorbid diseases, wound healing, spine surgery

Spondilolistezis cerrahisinde eşlik eden hastalıkların cerrahi ve klinik sonuçlara etkileri

Abstract

Amaç: Komorbiditelerin yönetimi, özellikle yara iyileşmesi ve ağrı yönetimi bağlamında, cerrahiden elde edilen klinik sonuçlar üzerinde önemli bir etkiye sahiptir. Bu çalışma komorbiditesi olan (vaka grubu) ve olmayan (kontrol grubu) cerrahi hastalarını iyileşme sonuçlarına göre karşılaştırmayı amaçlamaktadır.
Metod: Cerrahi hastalar N = 150 vaka grubuna (n=75) ve kontrol grubuna (n=75) kaydedildi. Temel demografik veriler, Görsel Analog Skalasına (VAS) dayalı preoperatif ve postoperatif ağrı düzeyleri, taburculuk sonuçları ve yara iyileşmesinin değerlendirilmesi toplandı ve karşılaştırıldı. Yara iyileşmesini etkileyen faktörler çok değişkenli lojistik regresyon kullanılarak değerlendirildi ve ameliyat sonrası ağrının belirleyicileri çok değişkenli doğrusal regresyon ile incelendi.
Bulgular: Demografik veriler, grupların yaş (p = 0.122) ve cinsiyet (p=0.758) açısından benzer olduğunu ortaya koydu. Vaka grubunun ortalama Vücut Kitle İndeksi (VKİ) 28.9±3.4 ile kontrol grubunun ortalama VKİ’si olan 25.7±2.9’dan daha yüksekti (p < 0:001). Preop (7.5 ± 1.2 vs 6.8 ± 1.1, p =0.001) ve postop 4.8 ± 1.5 vs 3.2 ± 10, p <0-001, ağrı skorları vaka grubunda anlamlı olarak daha yüksekti. Bu durum özellikle vaka grubu için geçerlidir, çünkü kontrol grubunun %73,3’üne kıyasla sadece %40’ı 24 saat veya daha kısa sürede taburcu edilmiştir (p < 0,001). Tüm yaraların iyileşmesi kontrol grubunda %90,7 iken vaka grubunda %66,7 olmuştur (p < 0,001) ve gecikmiş iyileşme vaka grubunda önemli ölçüde daha fazla olmuştur (%33,3’e karşı %9,3, p = 0,002). Çok değişkenli analizde, vaka grubunda tam yara iyileşmesi için odds oranı 0.25 (p < 0.001) iken, grup durumu, yaş, BMI ve diabetes mellitus ameliyat sonrası ağrının önemli belirleyicileriydi.
Sonuç: Bu bulgular, kaynakların spondilolistezis ameliyatı öncesi değerlendirmelere ve sık görülen sorunlarla ilgili hastalıkları / bozuklukları olan hastalar için ameliyat sonrası iyileşme stratejilerine yönlendirilmesi gerektiğini vurgulamaktadır.

Keywords

spondilolistezis, komorbid hastalıklar, yara iyileşmesi, omurga cerrahisi

References

• Fahmy MM, Hassan MES, Ismaeil AS, Kelany A, Wanis AE. Overview of clinical assessment principles of treatment of lumbar spondylolithesis. Tob Regul Sci. 2023;9(1):2914-2928. doi:10.18001/TRS.9.1.200
• García-Ramos C, Valenzuela-González J, Baeza-Álvarez VB, Rosales-Olivarez LM, Alpizar-Aguirre A, Reyes-Sánchez A. Degenerative spondylolisthesis I: general principles. Acta Ortop Mex. 2020;34(5):324-328. doi:10.35366/97997 
• Daher M, Rezk A, Baroudi M, et al. Lumbar spondylolisthesis grading: current standards and important factors to consider for management. World Neurosurg. 2024;190:311-317. doi:10.1016/j.wneu.2024.07.194
• Vanti C, Ferrari S, Guccione AA, Pillastrini P. Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment. Arch Physiother. 2021;11(1):19. doi:10.1186/s40945-021-00113-2
• Hsu HC, Chang CJ, Tung HH, Wang TJ. Disability, emotional distress and well-being among patients with lumbar spondylolisthesis. J Clin Nurs. 2019;28(21-22):3866-3878. doi:10.1111/jocn.14992
• Mirzamohammadi E, Ghandhari H, Pirbornatan M, Mohammadi S, Hosseininejad M. Assessment of disability levels in patients with low back pain based on the type of lumbar spinal disorder. J Back Musculoskelet Rehabil. 2021;34(1):131-137. doi:10.3233/BMR-191679
• Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without usion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021;385(6):526-538. doi:10.1056/NEJMoa2100990
• Mohile NV, Kuczmarski AS, Lee D, Warburton C, Rakoczy K, Butler AJ. Spondylolysis and isthmic spondylolisthesis: a guide to diagnosis and management. J Am Board Fam Med. 2022;35(6):1204-1216. doi:10.3122/jabfm.2022.220130R1
• Traistaru MR, Kamal D, Kamal C, Alexandru DO, Neamtu S-D, Bumbea AM. Quality of life in osteoporotic patients with low-grade degenerative spondylolisthesis. Signa Vitae. 2022;18(6):66-75. doi:10. 22514/sv.2022.022
• Buyuk AF, Shafa E, Dawson JM, Schwender JD. Complications with minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis in the obese population. Spine (Phila Pa 1976). 2019;44(23):E1401-E1408. doi:10.1097/BRS.0000000000003160
• Bays A, Stieger A, Held U, et al. The influence of comorbidities on the treatment outcome in symptomatic lumbar spinal stenosis: a systematic review and meta-analysis. N Am Spine Soc J. 2021;6:100072. doi:10.1016/j. xnsj.2021.100072
• Urakawa H, Jones T, Samuel A, et al. The necessity and risk factors of subsequent fusion after decompression alone for lumbar spinal stenosis with lumbar spondylolisthesis: 5 years follow-up in two different large populations. Spine J. 2020;20(10):1566-1572. doi:10.1016/j.spinee.2020. 04.026
• Mazurek M, Kulesza B, Gołębiowska N, Tyzo B, Kura K, Szczepanek D. Factors predisposing to the formation of degenerative spondylolisthesis-a narrative review. Medicina (Kaunas). 2023;59(8):1430. doi:10.3390/medicina 59081430
• Rivollier M, Marlier B, Kleiber J-C, Eap C, Litre C-F. Surgical treatment of high-grade spondylolisthesis: technique and results. J Orthop. 2020; 22:383-389. doi:10.1016/j.jor.2020.08.015
• Chakravarthy V, Patel A, Kemp W, Steinmetz M. Surgical treatment of lumbar spondylolisthesis in the elderly. Neurosurg Clin N Am. 2019; 30(3):341-352. doi:10.1016/j.nec.2019.02.008
• Wollowick AL, Sarwahi V. Spondylolisthesis: Diagnosis, Non-Surgical Management, and Surgical Techniques: Springer Nature; 2023.
• Karsy M, Chan AK, Mummaneni PV, et al. Outcomes and complications with age in spondylolisthesis: an evaluation of the elderly from the quality outcomes database. Spine (Phila Pa 1976). 2020;45(14):1000-1008. doi:10.1097/BRS.0000000000003441
• Inose H, Kato T, Onuma H, et al. Predictive factors affecting surgical outcomes in patients with degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976). 2021;46(9):610-616. doi:10.1097/BRS.0000000000003944
• Agarwal N, Aabedi AA, Chan AK, et al. Leveraging machine learning to ascertain the implications of preoperative body mass index on surgical outcomes for 282 patients with preoperative obesity and lumbar spondylolisthesis in the quality outcomes database. J Neurosurg Spine. 2022;38(2):182-191. doi:10.3171/2022.8.SPINE22365
• Lubis DU, Harahap EE, Iqbal KM. Correlation of body-mass index, age and gender with the degree of spondylolisthesis on lumbosacral xray photos at Haji Adam Malik Hospital Medan. Med Res Nurs Health Midwife Participat. 2024;5(3):133-144. doi:10.59733/medalion.v5i3.124
• Adogwa O, Davison MA, Vuong V, et al. Sex Differences in opioid use in patients with symptomatic lumbar stenosis or spondylolisthesis undergoing lumbar decompression and fusion. Spine (Phila Pa 1976). 2019;44(13):E800-E807. doi:10.1097/BRS.0000000000002965
• Laratta J, Carreon LY, Buchholz AL, et al. Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective quality outcomes database registry. J Neurosurg Spine. 2020;33(5):635-642. doi:10.3171/2020.4.SPINE20296
• Bond M, Evaniew N, Bailey CS, et al. Back pain in surgically treated degenerative lumbar spondylolisthesis: what can we tell our patients? Spine J. 2020;20(12):1940-1947. doi:10.1016/j.spinee.2020.08.009
• Schneider N, Fisher C, Glennie A, et al. Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse. Spine J. 2021;21(5):821-828. doi:10.1016/j.spinee.2020.11.010
• Inculet C, Urquhart JC, Rasoulinejad P, et al. Factors associated with using an interbody fusion device for low-grade lumbar degenerative versus isthmic spondylolisthesis: a retrospective cohort study. J Neurosurg Spine. 2021;35(3):299-307. doi:10.3171/2020.11.SPINE201261
• Goh GS, Yue WM, Guo CM, Tan SB, Chen JLT. Does the predominant pain location influence functional outcomes, satisfaction, and return to work after minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis? Clin Spine Surg. 2022;35(1): E143-E149. doi:10.1097/BSD.0000000000001193
• Farmer S, Choi D. Spinal Column and Spinal Cord Disorders. Neurology: A Queen Square Textbook. 2016.
• Mummaneni PV, Bydon M, Knightly J, et al. Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the quality outcomes database. J Neurosurg Spine. 2019;32(4):523-532. doi:10.3171/2019.9.SPINE19644
• Rabah NM, Khan HA, Shost M, Beckett J, Mroz TE, Steinmetz MP. Predictors of operative duration and complications in single-level posterior interbody fusions for degenerative spondylolisthesis. World Neurosurg. 2021;151:e317-e323. doi:10.1016/j.wneu.2021.04.034
• Fatima N, Zheng H, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Development and validation of machine learning algorithms for predicting adverse events after surgery for lumbar degenerative spondylolisthesis. World Neurosurg. 2020;140:627-641. doi:10.1016/j.wneu.2020.04.135
• Ge Z, Liu X, Jing X, et al. Logistic regression model predicts early surgical site infection after spinal fusion: a retrospective cohort study. J Hosp Infect. 2024;149:65-76. doi:10.1016/j.jhin.2024.04.018
• Khan JM, Harada GK, Basques BA, et al. Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results. Spine J. 2020;20(2):276-282. doi:10.1016/j.spinee.2019.09.021