Multi-domain biopsychosocial postoperative recovery trajectories associate with patient outcomes following lumbar fusion.
Multi-domain biopsychosocial postoperative recovery trajectories associate with patient outcomes following lumbar fusion.
复制标题
多领域生物心理社会术后恢复轨迹与腰椎融合后患者的预后相关。
DOI：
10.1007/s00586-023-07572-0
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Bailey,JeannieF
中科院分区：
文献类型：
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作者：
Halvorson,RyanT;Torres-Espin,Abel;Callahan,Matthew;Tay,Bobby;O'Neill,Conor;Berven,Sigurd;Lotz,JeffreyC;Bailey,JeannieF
目的本研究的目的是描述和评估多域生物心理社会 (BPS) 恢复对腰椎融合术后结果的影响。我们假设将识别 BPS 恢复的离散模式（例如，集群），然后将其与术后结果和术前患者数据相关联。方法在基线和一年之间接受腰椎融合的患者的多个时间点收集患者报告的疼痛、残疾、抑郁、焦虑、疲劳和社会角色的结果。多变量潜在类别混合模型将复合恢复评估为 (1) 疼痛、(2) 疼痛和残疾以及 (3) 疼痛、残疾和其他 BPS 因素的函数。根据患者随时间的复合恢复轨迹将患者分配到不同的组。结果使用 510 名接受腰椎融合的患者的所有 BPS 结果，确定了三个多域术后恢复组：渐进 BPS 响应者 (11%)、快速 BPS 响应者 (36%) 和反弹响应者 (53%)。仅对疼痛或疼痛和残疾的恢复进行建模无法生成有意义或独特的恢复集群。 BPS 恢复簇与融合水平的数量和术前阿片类药物的使用有关。即使在调整混杂因素后，术后阿片类药物的使用 (p< 0.01) 和住院时间 (p< 0.01) 也与 BPS 恢复集群相关。结论本研究描述了源自多个 BPS 因素的腰椎融合后不同的恢复集群，这些因素与患者特定的术前因素和术后结果有关。了解跨多个健康领域的术后恢复轨迹将加深我们对 BPS 因素如何与手术结果相互作用的理解，并可为个性化护理计划提供信息。
PurposeThe purpose of this study is to describe and assess the impact of multi-domain biopsychosocial (BPS) recovery on outcomes following lumbar spine fusion. We hypothesized that discrete patterns of BPS recovery (e.g., clusters) would be identified, and then associated with postoperative outcomes and preoperative patient data.MethodsPatient-reported outcomes for pain, disability, depression, anxiety, fatigue, and social roles were collected at multiple timepoints for patients undergoing lumbar fusion between baseline and one year. Multivariable latent class mixed models assessed composite recovery as a function of (1) pain, (2) pain and disability, and (3) pain, disability, and additional BPS factors. Patients were assigned to clusters based on their composite recovery trajectories over time.ResultsUsing all BPS outcomes from 510 patients undergoing lumbar fusion, three multi-domain postoperative recovery clusters were identified: Gradual BPS Responders (11%), Rapid BPS Responders (36%), and Rebound Responders (53%). Modeling recovery from pain alone or pain and disability alone failed to generate meaningful or distinct recovery clusters. BPS recovery clusters were associated with number of levels fused and preoperative opioid use. Postoperative opioid use (p< 0.01) and hospital length of stay (p< 0.01) were associated with BPS recovery clusters even after adjusting for confounding factors.ConclusionThis study describes distinct clusters of recovery following lumbar spine fusion derived from multiple BPS factors, which are related to patient-specific preoperative factors and postoperative outcomes. Understanding postoperative recovery trajectories across multiple health domains will advance our understanding of how BPS factors interact with surgical outcomes and could inform personalized care plans.