Clinical StudyPatient-reported allergies predict postoperative outcomes and psychosomatic markers after spine surgery
Introduction
Collecting an accurate list of allergies from the medical history is critical for patient care. Importantly, it is unclear whether patient-reported allergies represent true allergic reactions, adverse effects, or other factors. For example, the most common patient-reported drug allergy is penicillin allergy. However, in one hospital cohort, only a minority of patients who have reported or have had a documented penicillin allergy in the medical record have been proven to be positive for penicillin via allergy testing or drug challenge [1]. Even if patient-reported allergies have not been verified through testing, they can still influence patient care. For example, patients who report penicillin allergies have increased broad-spectrum antibiotic use, greater antibiotic costs, and more frequent drug-resistant infections compared with those without the allergy as less optimal antimicrobial therapies may be used in treatment because of this reported allergy. These patients also experience longer hospital stays, more complicated hospital courses, increased likelihood of an intensive care unit admission, and increased risk of mortality during the hospitalization [1], [2], [3].
In addition, patient-reported allergies are also correlated with significant underlying psychosomatic burden. In a Canadian cohort, patient-reported allergies correlated with Axis I psychological disorders, including major depression, bipolar and panic disorders, and social phobia [4]. Other studies have shown a correlation between drug hypersensitivity reactions and anxiety [5], as well as between allergies and suicide mortality. The association between allergies and non-fatal suicidal behaviors is still unclear [6]. Finally, a cohort study of patients suffering from drug intolerance or insect venom allergies has shown that patients reporting these reactions have scored significantly higher on questionnaires measuring somatization and have worse health-related quality of life (QOL), frequently reporting higher levels of anxiety relative to the normal population [7].
In the present study, we investigated whether or not patients who self-report more allergies before undergoing cervical or lumbar spine surgery have worse outcomes after surgery. We hypothesized that patient-reported allergies are associated with poorer postoperative outcomes and higher admission costs and thus may serve as a prognostic factor for outcomes after spinal surgery.
Section snippets
Data collection
Institutional review board approval was obtained before study initiation. No patient consent was required, given the retrospective nature of the present study. A retrospective cohort study of all patients undergoing cervical or lumbar spine surgery at a tertiary care center between January 2009 and December 2014 was performed. Queried data were collected from institutional audited data warehouses and included demographics, comorbidities, insurance status, length of hospital stay, and operative
Results
Five hundred ninety-two cervical spine patients and 4,465 lumbar spine patients were included in the present study (Table 1). Patients had an average age of 56.2 and 60.8 years for cervical and lumbar procedures, respectively. The patient demographics were slightly predisposed toward men in both cervical (43% women) and lumbar (48% women) patient groups. However, when subset by the presence of allergies, women less often had no allergies among cervical (26%) and lumbar (29%) patients (Table S1,
Discussion
In the present study of over 5,000 patients undergoing cervical and lumbar spine surgeries, we identified numerous patients with extensive self-reported allergies. In this cohort, the number of patient-reported allergies was associated with superior postoperative improvements in pain-related QOL as measured by the PDQ. Additionally, the total number of allergies significantly correlated with higher admission costs and longer lengths of stay.
Previous studies have identified potential
Conclusions
In conclusion, patient-reported allergy burden is significantly correlated with reductions in postoperative pain burden, as well as increased costs of care during the hospital admission and longer lengths of stay, and thus may serve as a useful prognostic factor for these postsurgical outcomes. The relationship between patient-reported allergies and reduction in PDQ may be secondary to the effects of the expectation-actuality discrepancy, as this relationship was observed for patients with
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FDA device/drug status: Not applicable.
Author disclosures: DDX: Nothing to disclose. WY: Nothing to disclose. RX: Nothing to disclose. JAM: Nothing to disclose. TEM: Stock Ownership: PearlDiver Inc (none); Consulting: Globus Medical (B); Speaking and/or Teaching Arrangements: AOSpine (B), outside the submitted work. MPS: Nothing to disclose. SJN: Nothing to disclose. AGM: Stock Ownership: ATI (none), Cardionomics (none), Enspire (none); Consulting: Functional Neuromodulation (B), Spinal Modulation (B), St. Jude (B), outside the submitted work.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
This study was not supported by any kind of funding.
The authors declare no conflicts of interest associated with the study.
Institutional review board approval (16–153) was obtained before the start of the study.