Patient-Reported Allergies Do Not Affect Long-Term Patient-Reported Outcome Measures After Spine Surgery

Patawut Bovonratwet; Avani S. Vaishnav; Jung Kee Mok; Zamie Abdullah; Mahie Abdullah; Evan D. Sheha; Steven J. McAnany; Catherine H. Gang; Sheeraz A. Qureshi

doi:10.14444/8420

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Table 1

Characteristics of cervical spine surgery patients (N = 148).

Characteristic	n (%)
Age, y, mean ± SD	51.4 ± 12.3
Gender
Men	98 (66.2%)
Women	50 (33.8%)
Body mass index, mean ± SD	27.4 ± 5.7
Insurance
Medicare	16 (10.8%)
Workers’ compensation	2 (1.4%)
Commercial/private	130 (87.8%)
Preoperative narcotic use
No	129 (87.2%)
Yes	19 (12.8%)
Current smoker
No	131 (89.1%)
Yes	16 (10.9%)
Diabetes
No	6 (96.0%)
Yes	142 (4.1%)
Hypertension
No	116 (78.4%)
Yes	32 (21.6%)
CCI
0	119 (80.4%)
1	15 (10.1%)
≥2	14 (9.5%)
ASA classification
1	24 (16.4%)
≥2	122 (83.6%)
Percentage neck pain, mean ± SD	37.8 ± 34.9
Percentage radiculopathy, mean ± SD	62.9 ± 34.4
Preoperative depression
No	127 (85.8%)
Yes	21 (14.2%)
Preoperative anxiety
No	122 (82.4%)
Yes	26 (17.6%)
Preoperative affective disorder
No	146 (98.6%)
Yes	2 (1.4%)
Preoperative diagnosis
Central stenosis	2 (1.4%)
Degenerative disc disease	2 (1.4%)
Degenerative spondylolisthesis	10 (6.8%)
Foraminal stenosis	15 (10.1%)
Herniated nucleus pulposus	3 (2.0%)
Kyphosis	5 (3.4%)
Myelopathy	75 (50.7%)
Radiculopathy	32 (21.6%)
Vertebral fracture	2 (1.4%)
Other	2 (1.4%)
Cervical procedure
Cervical laminectomy/laminotomy/laminoforaminotomy	5 (3.4%)
Cervical foraminal decompression	13 (8.8%)
Cervical discectomy	7 (4.7%)
Cervical total disc replacement	51 (34.5%)
Anterior cervical discectomy and fusion	69 (46.6%)
Posterior cervical fusion	3 (2.0%)
Preoperative PROMs, mean ± SD
Neck Disability Index	35.4 ± 18.4
VAS neck pain	4.9 ± 3.0
VAS arm pain	4.7 ± 3.4
SF-12 PCS	37.5 ± 9.3
SF-12 MCS	47.9 ± 11.0
PROMIS	41.4 ± 7.8

Note: Data presented as n (%) except where otherwise noted.
ASA, American Society of Anesthesiologists; CCI, Charlson Comorbidity Index; PROM, patient-reported outcome measure; PROMIS, patient-reported outcomes measurement information system; SF-12 MCS, short form-12 mental component score; SF-12 PCS, short form-12 physical component score; VAS, visual analog scale.

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Table 2

Characteristics of lumbar spine surgery patients (N = 517).

Characteristic	n (%)
Age, y, mean ± SD	57.1 ± 15.4
Gender
Men	303 (58.6%)
Women	214 (41.4%)
Body mass index, mean ± SD	27.1 ± 5.3
Insurance
Medicare	120 (23.2%)
Workers’ compensation	4 (0.8%)
Commercial/private	385 (74.5%)
Medicaid	1 (0.2%)
Other	7 (1.4%)
Preoperative narcotic use
No	401 (77.7%)
Yes	115 (22.3%)
Current smoker
No	486 (94.0%)
Yes	31 (6.0%)
Diabetes
No	483 (96.0%)
Yes	34 (4.1%)
Hypertension
No	338 (78.4%)
Yes	179 (21.6%)
Charlson Comorbidity Index
0	385 (74.5%)
1	59 (11.4%)
≥2	73 (14.1%)
American Society of Anesthesiologists classification
1	65 (12.8%)
≥2	442 (87.2%)
Percentage back pain, mean ± SD	34.1 ± 33.5
Percentage radiculopathy, mean ± SD	66.0 ± 33.6
Preoperative depression
No	452 (87.4%)
Yes	65 (12.6%)
Preoperative anxiety
No	429 (83.0%)
Yes	88 (17.0%)
Preoperative affective disorder
No	512 (99.0%)
Yes	5 (1.0%)
Preoperative diagnosis
Cauda equina	2 (0.4%)
Central stenosis	4 (0.8%)
Degenerative disc disease	3 (0.6%)
Degenerative scoliosis	27 (5.2%)
Degenerative spondylolisthesis	23 (4.4%)
Discitis	2 (0.4%)
Facet cyst	35 (6.8%)
Flatback syndrome	6 (1.2%)
Foraminal stenosis	27 (5.2%)
Herniated nucleus pulposus	68 (13.2%)
Lateral recess stenosis	231 (44.7%)
Radiculopathy	66 (12.8%)
Spondylolysis	14 (2.7%)
Vertebral fracture	5 (1.0%)
Other	1 (0.2%)
Lumbar procedure
Lumbar laminectomy/laminotomy/laminoforaminotomy	38 (7.4%)
Lumbar foraminal decompression	73 (14.1%)
Lumbar discectomy	192 (37.1%)
Lumbar total disc replacement	4 (0.8%)
Transforaminal lumbar interbody fusion	109 (21.1%)
Lateral lumbar interbody fusion	17 (3.3%)
Anterior lumbar interbody fusion	21 (4.1%)
Posterior lumbar interbody fusion	63 (12.2%)
Preoperative PROMs, mean ± SD
Oswestry Disability Index	39.9 ± 19.7
Vsual analog scale back pain	5.3 ± 3.1
Visual analog scale leg pain	5.8 ± 3.2
Short form-12 physical component score	32.7 ± 8.8
Short form-12 mental component score	47.3 ± 11.8
PROMIS	35.5 ± 7.8

Note. Data presented as n (%) except where otherwise noted.
PROM, patient-reported outcome measures; PROMIS, patient-reported outcomes measurement information system.

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Table 3

Prevalence of preoperative allergies.

Types of Allergies	n (%)
Cervical Spine
Total	148 (100.0%)
Total allergies
0	86 (58.1%)
1	25 (16.9%)
2	15 (10.1%)
≥3	22 (14.9%)
Total medical allergies
0	103 (69.6%)
1	22 (14.9%)
2	13 (8.8%)
≥3	10 (6.8%)
Total environment/food/other allergies
0	112 (75.7%)
1	24 (16.2%
2	4 (2.7%)
≥3	8 (5.4%)
Lumbar Spine
Total	517 (100.0%)
Total allergies
0	266 (51.5%)
1	129 (25.0%)
2	48 (9.3%)
≥3	74 (14.3%)
Total medical allergies
0	324 (62.7%)
1	125 (24.2%)
2	37 (7.2%)
≥3	31 (6.0%)
Total environment/food/other allergies
0	393 (76.0%)
1	77 (14.9%)
2	25 (4.8%)
≥3	23 (4.4%)

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Table 4

Multivariable analysis of association between number of total allergies and patient-reported outcome measures in cervical spine surgery.

Cervical Spine	β Coefficient	P Value^{^a}
2-wk PROMs
NDI	1.43	0.162
VAS neck pain	0.41	0.009
VAS arm pain	0.39	0.015
SF-12 PCS	−0.31	0.517
SF-12 MCS	0.30	0.596
PROMIS	−0.93	0.055
12-wk PROM
NDI	1.06	0.293
VAS neck pain	0.34	0.009
VAS arm pain	0.04	0.796
SF-12 PCS	−1.84	0.004
SF-12 MCS	0.16	0.757
PROMIS	−1.41	0.021
6-mo PROM
NDI	1.22	0.271
VAS neck pain	−0.002	0.990
VAS arm pain	−0.06	0.750
SF-12 PCS	−0.95	0.248
SF-12 MCS	−1.22	0.084
PROMIS	−1.03	0.167
1-y PROM
NDI	0.20	0.899
VAS neck pain	0.19	0.406
VAS arm pain	0.03	0.893
SF-12 PCS	−0.35	0.732
SF-12 MCS	−0.14	0.857
PROMIS	−1.66	0.072

↵a Multivariable linear regression controlling for gender, CCI, ASA, and preoperative PROMIS.
ASA, American Society of Anesthesiologists; CCI, Charlson Comorbidity Index; NDI, Neck Disability Index; PROM, patient-reported outcome measures; PROMIS, patient-reported outcomes measurement information system; SF-12 MCS, short form-12 mental component score; SF-12 PCS, short form-12 physical component score; VAS, visual analog scale.

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Table 5

Multivariable analysis of association between number of total allergies and patient-reported outcome measures in lumbar spine surgery.

Lumbar Spine	β Coefficient	P Value^{^a}
2-wk PROMs
ODI	0.48	0.438
VAS back pain	−0.03	0.768
VAS leg pain	0.02	0.841
SF-12 PCS	−0.31	0.227
SF-12 MCS	0.58	0.066
PROMIS	−0.78	0.002
12-wk PROMs
ODI	−0.003	0.996
VAS back pain	0.09	0.257
VAS leg pain	−0.01	0.916
SF-12 PCS	−0.32	0.363
SF-12 MCS	0.56	0.088
PROMIS	0.09	0.781
6-mo PROMs
ODI	−0.33	0.653
VAS back pain	−0.05	0.637
VAS leg pain	0.01	0.889
SF-12 PCS	−0.15	0.727
SF-12 MCS	0.23	0.564
PROMIS	0.08	0.844
1-y PROMs
ODI	0.6	0.420
VAS back pain	0.04	0.703
VAS leg pain	0.18	0.130
SF-12 PCS	−0.54	0.272
SF-12 MCS	0.65	0.160
PROMIS	0.38	0.395

↵a Multivariable linear regression controlling for gender, CCI, ASA, and preoperative depression.
ASA, American Society of Anesthesiologists; CCI, Charlson Comorbidity Index; ODI, Oswestry Disability Index; PROM, patient-reported outcome measure; PROMIS, patient-reported outcomes measurement information system; SF-12 MCS, short form-12 mental component score; SF-12 PCS, short form-12 physical component score; VAS, visual analog scale.

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Table 6

Multivariable analysis of association between number of total allergies and achieving minimal clinically important difference at 1 y in cervical spine surgery.

Cervical Spine	RR	P Value^{^a}
Neck Disability Index
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1.15	0.717
2 Patient-reported allergies	1.29	0.597
≥3 Patient-reported allergies	1.11	0.843
VAS neck pain
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1.73	0.258
2 Patient-reported allergies	1.63	0.378
≥3 Patient-reported allergies	1.92	0.218
VAS arm pain
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.80	0.552
2 Patient-reported allergies	0.78	0.598
≥3 Patient-reported allergies	0.69	0.487
SF-12 PCS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1.48	0.446
2 Patient-reported allergies	1.60	0.425
≥3 Patient-reported allergies	1.56	0.467
SF-12 MCS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1.35	0.603
2 Patient-reported allergies	0.80	0.773
≥3 Patient-reported allergies	2.01	0.268
PROMIS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1.77	0.246
2 Patient-reported allergies	2.11	0.173
≥3 Patient-reported allergies	1.70	0.392

↵a Multivariable linear regression controlling for gender, CCI, ASA, and preoperative PROMIS.
ASA, American Society of Anesthesiologists; CCI, Charlson Comorbidity Index; PROMIS, patient-reported outcomes measurement information system; Ref, reference; SF-12 MCS, short form-12 mental component score; SF-12 PCS, short form-12 physical component score; VAS, visual analog scale.

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Table 7

Multivariable analysis of association between number of total allergies and achieving minimal clinically important difference at 1 y in lumbar spine surgery.

Lumbar Spine	RR	P Value^{^a}
Oswestry Disability Index
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.94	0.793
2 Patient-reported allergies	1.04	0.876
≥3 Patient-reported allergies	1.05	0.883
VAS back pain
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.99	0.958
2 Patient-reported allergies	0.99	0.983
≥3 Patient-reported allergies	0.74	0.428
VAS leg pain
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.92	0.744
2 Patient-reported allergies	0.95	0.844
≥3 Patient-reported allergies	0.99	0.976
SF-12PCS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.68	0.081
2 Patient-reported allergies	0.62	0.064
≥3 Patient-reported allergies	0.8	0.494
SF-12 MCS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	0.93	0.853
2 Patient-reported allergies	1.13	0.773
≥3 Patient-reported allergies	2.11	0.092
PROMIS
0 Patient-reported allergies	Ref
1 Patient-reported allergy	1	0.987
2 Patient-reported allergies	1.06	0.816
≥3 Patient-reported allergies	0.92	0.821

↵a Multivariable linear regression controlling for gender, CCI, ASA, preoperative depression
ASA, American Society of Anesthesiologists; CCI, Charlson Comorbidity Index; PROMIS, patient-reported outcomes measurement information system; Ref, reference; SF-12 MCS, short form-12 mental component score; SF-12 PCS, short form-12 physical component score; VAS, visual analog scale.