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Factors Predicting Outcomes in ODI and EQ5D Two Years After Surgery for Grade 2 Spondylolisthesis: An Extreme-Group Design Analysis using Quality Outcomes Database

Friday, May 3, 2024

Presenting Author(s)

Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US

Co-Author(s)

Ken Porche, MD

Spine Fellow
University of Utah
Salt Lake City, UT, US
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Anthony M. DiGiorgio, DO, MHA

Assistant Professor
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
OG

Oren N. Gottfried, MD

Professor of Neurosurgery
Duke University
Durham, North Carolina, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
Juan S. Uribe, MD

Neurosurgeon
Barrow Neurological Insitute
Phoenix, Arizona, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Introduction: High-grade spondylolisthesis poses a significant challenge to patients’ disability and quality of life. Outcomes following surgery can vary considerably among patients. Understanding the factors that predict poor or good outcomes in terms of Oswestry Disability Index (ODI) scores and quality of life (EQ5D) two years after surgery is critical for optimizing patient care and surgical decision-making.

Methods: Data from the Quality Outcomes Database (QOD) High Grade Spondylolisthesis (HGS) dataset was analyzed. We categorized patients who underwent surgery for grade 2 spondylolisthesis (G2S) into two distinct groups based on their two-year postoperative ODI and EQ5D scores compared to their baseline scores: those with poor outcomes (lowest 20th percentile) and those with good outcomes (highest 20th percentile). Multivariate binary logistic regression models were then developed to identify factors influencing these extreme outcomes

Results: Out of 400 patients in the HGS QOD database with G2S, 318 met the inclusion criteria. Based on multivariate analyses, factors associated with the best vs worst ODI outcome included baseline leg weakness (OR 3.4, p=0.034) and higher baseline ODI scores (OR 3.4/10 pts, p<.0001). Factors associated with the best vs worst EQ5D outcome included only lower baseline EQ5D scores (OR 4.4/10%, p<.0001). There was an association between best and worst ODI outcomes and length of hospital stay (3.2 days vs 4.0 days, p=0.025); however, this was not demonstrated with multivariate analyses. No significant associations were found for readmission or reoperation between patients with best vs worst outcomes.

Conclusion : In conclusion, our extreme-group design analysis highlights key predictors of outcomes in ODI and EQ5D scores two years after surgery for grade 2 spondylolisthesis. Factors such as baseline leg weakness, ODI scores significantly influence ODI outcomes, while only lower baseline EQ5D scores were found to be the key determinant of EQ5D outcomes. These findings provide valuable insights for optimizing patient care and surgical decision-making in this patient population.