One-in-five older adults regret their decision to undergo corrective surgery for adult spinal deformity (ASD), new research—published in the journal Spine by Owoicho Adogwa (University of Cincinnati College of Medicine, Cincinnati, USA) et al—has found.
The retrospective single-centre study showed that while the majority of older adults (≥65 years old) were appropriately counselled and satisfied with their decision, 21% regretted their choice to have surgery. In addition, preoperative depression was associated with medium/high decisional regret according to multivariate analysis.
Older adults with ASD who underwent spinal surgery at a quaternary medical centre from January 1, 2016 to March 1, 2019, were enrolled in the study. Patients were categorised into medium/high or low-decisional regret cohorts based on their responses to the Ottawa decision regret questionnaire. Decisional regret assessments were completed 24 months after surgery.
The primary outcome measure was prevalence of decisional regret after surgery. Factors associated with high decisional regret were analysed by multivariate logistic regression.
In total, 155 patients (mean age, 69.5 years) met the inclusion criteria. Overall, 80% agreed that having surgery was the right decision for them, and 77% would make the same choice in future. A total of 21% regretted the choice that they made, and 21% responded that surgery caused them harm.
Comparing patient cohorts reporting medium/high- versus low-decisional regret, there were no differences in baseline demographics, comorbidities, invasiveness of surgery, length of stay, discharge disposition, or extent of functional improvement 12-months after surgery.
After adjusting for sex, American Society of Anesthesiologists score, invasiveness of surgery, and presence of a postoperative complication, older adults with preoperative depression had four-fold increased odds of high-decisional regret (p=0.04). Change in health related quality of life measures were similar between all groups at 12-months after surgery.
Speaking to Spinal News International, Adogwa said: “This is an important topic that has largely been under-studied. With the ageing of the baby boomers, 30% of all surgical procedures performed over the next 30 years will be in patients over the age of 65. This is particularly relevant for musculoskeletal disorders—such as spine.
“Approximately seven million older adults have depression, and only 10% get professional help for depression. The co-prevalence of depression and spinal disorders, places older adults at risk for poor convalescence and outcomes, particularly after surgery.
“Our best chance of improving surgical outcomes, decreasing decisional regret and healthcare resource utilisation among older adults considering surgery for spinal deformity requires a paradigm shift away from disease-specific care to patient patient-cantered. In other words, aligning care received with the patient’s specific health outcome goals and healthcare preferences. It is our hope that this article contributes to that conversation.”