THE IMPACT OF WAIT TIME ON OUTCOME IN PATIENTS UNDERGOING ELECTIVE POSTERIOR LUMBAR SPINAL SURGERY

Abstract

To evaluate the effect of wait time to surgery on patient derived generic and disease-specific functional outcome following lumbar surgery.

Study cohort of seventy patients undergoing elective posterior lumbar spinal surgery for degenerative conditions. Prospectively collected SF-36 and Oswestry Disability questionnaires administered preoperatively, six weeks, six months, one year postoperatively. Time intervals from onset of symptoms to initial consultation by family physician through investigations, spinal surgical consultation and time spent on the surgical waiting list to surgery quantified. Time intervals compared to patient-specific improvements in reported outcome following surgery using Cox-Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using median time as a reference for patients with either a longer or shorter wait.

Patient follow-up completed in fifty-three (76%). Improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores (p< 0.05). The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in surgical outcome (p< 0.05, SF-36 domains BP, GH, RP, VT, and Physical Component Scores). The greatest impact observed was a prolonged surgical wait-list time on SF-36 PCS scores following surgery (Hazard’s ratio 3.53). Patients requiring spinal fusion had a longer wait when compared to those not requiring fusion (p< 0.05).

A longer wait time to spinal surgery can negatively influence surgical results as quantified by patient derived functional outcome measures. Surgery resulted in the greatest improvement in pain severity and physical aspects of function, however, these areas also appeared the most impacted by a longer wait to surgery.