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Impact of American Society of Anesthesiologists’ Classification on Postoperative Satisfaction and Clinical Outcomes Following Lumbar Decompression: Cohort-Matched Analysis – Lumbar Spinal Stenosis

The article is a retrospective cohort study that aims to compare patient-reported outcomes (PROMs), minimum clinically important difference (MCID) achievement, and postoperative satisfaction following minimally invasive lumbar decompression in patients stratified by American Society of Anesthesiologists (ASA) classification. The study found that ASA≥3 patients may achieve similar long-term clinical outcomes to ASA<3 patients, but they may show poorer short-term satisfaction for disability, leg pain, and back pain, which could be related to differing preoperative expectations. No significant differences were found in mean PROMs and MCID achievement between the two groups. However, ASA≥3 patients experienced increased length of stay and postoperative narcotic consumption on surgery day. Overall, the study suggests that ASA classification does not necessarily predict long-term outcomes but may have an impact on short-term satisfaction in certain aspects Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: ASA≥3 patients may achieve similar long-term clinical outcomes to ASA<3 patients, though they may show poorer short-term satisfaction for disability, leg pain, and back pain, which could be related to differing preoperative expectations. Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Clin Spine Surg. 2023 Oct 30. doi: 10.1097/BSD.0000000000001553. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort.OBJECTIVE: The aim was to compare patient-reported outcomes (PROMs), minimum clinically important difference (MCID) achievement, and postoperative satisfaction following minimally invasive lumbar decompression in patients stratified by American Society of Anesthesiologists (ASA) classification.SUMMARY OF BACKGROUND DATA: Some guidelines recommend against performing,

Clin Spine Surg. 2023 Oct 30. doi: 10.1097/BSD.0000000000001553. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort.

OBJECTIVE: The aim was to compare patient-reported outcomes (PROMs), minimum clinically important difference (MCID) achievement, and postoperative satisfaction following minimally invasive lumbar decompression in patients stratified by American Society of Anesthesiologists (ASA) classification.

SUMMARY OF BACKGROUND DATA: Some guidelines recommend against performing elective procedures for patients with an ASA score of 3 or greater; however, long-term postoperative outcomes are not well described.

METHODS: Primary, single-level, minimally invasive lumbar decompression procedures were identified. PROMs were administered at preoperative, 6-week, 12-week, 6-month, 1-year, 2-year timepoints and included Patient-Reported Outcomes Measurement Information System-Physical Function, visual analog scale (VAS) back/leg, Oswestry disability index (ODI), and 12-item short form physical component score. Satisfaction scores were collected postoperatively for VAS back/leg, ODI, and individual ODI subcategories. Patients were grouped (ASA<3, ASA≥3), and propensity scores were matched to control for significant differences. Demographic and perioperative characteristics were compared using χ2 and the Student's t test. Mean PROMs and postoperative satisfaction were compared at each time point by a 2-sample t test. Postoperative PROM improvement from the preoperative baseline within each cohort was calculated with a paired t test. MCID achievement was determined by comparing ΔPROMs to established thresholds and comparing between groups using simple logistic regression.

RESULTS: One hundred and twenty-nine propensity-matched patients were included: 99 ASA<3 and 30 ASA≥3. No significant demographic differences were observed between groups. ASA≥3 patients experienced significantly increased length of stay and postoperative narcotic consumption on surgery day (P<0.048, all). Mean PROMs and MCID achievement did not differ. The ASA<3 cohort significantly improved from the preoperative baseline for all PROMs at all postoperative time points. ASA<3 patients demonstrated higher levels of postoperative satisfaction at 6 weeks for VAS leg, VAS back, ODI, sleeping, lifting, walking, standing, sex, travel, and at 6 months for VAS back (P<0.045, all).

CONCLUSION: ASA≥3 patients may achieve similar long-term clinical outcomes to ASA<3 patients, though they may show poorer short-term satisfaction for disability, leg pain, and back pain, which could be related to differing preoperative expectations.

PMID:37941112 | DOI:10.1097/BSD.0000000000001553

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Impact of American Society of Anesthesiologists’ Classification on Postoperative Satisfaction and Clinical Outcomes Following Lumbar Decompression: Cohort-Matched Analysis

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Clin Spine Surg. 2023 Oct 30. doi: 10.1097/BSD.0000000000001553. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort.OBJECTIVE: The aim was to compare patient-reported outcomes (PROMs), minimum clinically important difference (MCID) achievement, and postoperative satisfaction following minimally invasive lumbar decompression in patients stratified by American Society of Anesthesiologists (ASA) classification.SUMMARY OF BACKGROUND DATA: Some guidelines recommend against performing
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