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ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 21-26

Quality of life in post lumbar microdiscectomy patients using the EuroQol 5-dimension 5-level scale


1 Division of Neurosurgery, Department of Surgery, King Khalid University; Department of Neurosurgery, Aseer Central Hospital, Abha, Saudi Arabia
2 Division of Neurosurgery, Department of Surgery, King Khalid University, Abha, Saudi Arabia
3 Department of Neurosurgery, Aseer Central Hospital; Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia
4 Department of Family and Community Medicine, King Khalid University, Abha, Saudi Arabia

Date of Submission01-Aug-2019
Date of Acceptance18-Nov-2019
Date of Web Publication19-Jan-2021

Correspondence Address:
Dr. Ibrahim Alnaami
Division of Neurosurgery, Department of Surgery, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_31_19

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  Abstract 

Objectives: The current study aimed to assess the impact of microdiscectomy surgery on quality of life (QOL) in postoperative patients across many facets of life to identify the most commonly affected ones. Our research question was, “does majority of postlumbar microdiscectomy patients have good QOL postsurgery?”
Patients and Methods: In a single tertiary care center in southern region, Saudi Arabia, ninety-seven patients who underwent discectomy at Aseer Central Hospital (ACH) in southwestern Saudi Arabia from 2015 to 2017 were included in this study. ACH is the only tertiary care center in Asir province. Patients with spinal fractures or incomplete files were excluded. Patients' files were reviewed for data extraction. A phone call was made to all patients and they were asked to answer the five questions of the five domains of the EuroQoL 5-dimension 5-level (EQ-5D-5 L) QOL questionnaire. After considering other variables and adjusting for potential confounders, we assessed the amount of patients' satisfaction in the 5 domains of EQ-5D-5 L.
Results: The study included 97 patients whose ages ranged from 28 to 56 years with a mean age of 42.6 ± 10.8 years. Nearly 61% of the patients were male. In all, 56.7% of patients reported a high QOL, while 4.1% of them had a poor QOL. About 82% of the included patients had no or minimal self-care problems, while 65.9% of the patients had no or minimal pain.
Conclusions: The researchers concluded that about half of the patients who underwent lumbar microdiscectomy had a high QOL. The greatest improvements following microdiscectomy were recorded for self-care, mobility, and psychological status, while the lowest improvements were noted for pain and discomfort.

Keywords: Discectomy, EuroQoL 5-dimension 5-level, lumbar, quality of life


How to cite this article:
Alnaami I, Shakir S, Almalwi K, Alquzi A, Asiri M, Asiri M, Alqahtani N, Shehata SF. Quality of life in post lumbar microdiscectomy patients using the EuroQol 5-dimension 5-level scale. Saudi Surg J 2020;8:21-6

How to cite this URL:
Alnaami I, Shakir S, Almalwi K, Alquzi A, Asiri M, Asiri M, Alqahtani N, Shehata SF. Quality of life in post lumbar microdiscectomy patients using the EuroQol 5-dimension 5-level scale. Saudi Surg J [serial online] 2020 [cited 2021 Feb 28];8:21-6. Available from: https://www.saudisurgj.org/text.asp?2020/8/1/21/307418


  Introduction Top


Evaluating of quality of life (QOL) is vital for patients with spinal disorders who undergo spinal surgery particularly lumbar microdiscectomy, as this procedure can have a major impact on patients' lives. Low back pain caused by acute disc herniation is a common disorder among middle-aged patients. Spinal consequences arising from trauma, deformity, and degenerative disease processes may be detrimental to daily life quality.[1],[2] Spinal surgery in general and microdiscectomy in particular, as a medical intervention has been studied extensively in the last few years.[3],[4]

Lumbar microdiscectomy can affect many aspects of life, including mobility, self-care, daily activities, and one's sex life. These effects are due to the long-term consequences associated with this procedure, including ongoing pain, anxiety, depression, and potential loss of reproductive function due to postsurgical mechanical, neurologic, and psychological factors.[5] Studying and evaluating these effects is vital, as it is important to understand the direct and indirect relationship between lumbar microdiscectomy and overall QOL.[6],[7],[8] In fact, health-related QOL (HRQoL) has become an important measure in clinical trials in patients with primary brain tumors,[5] cerebrovascular disease,[9] and spinal disease.[10]

The assessment of QOL resulting from medical interventions can serve as a useful source of data used by clinicians, researchers, and patients to guide treatment decisions and prognosis.[11] HRQoL data can also be a critical factor in understanding new treatments, not simply in terms of traditional endpoints, such as survival, but also in terms of understanding what that additional survival can mean to each patient.[12] Although patients can be highly involved in the medical decision-making process, studies usually concentrate on medical perspectives that report on patient morbidity and mortality, while forgetting the biopsychosocial approach that should be patient oriented. In the process of obtaining informed consent before surgery, as also reported by Neil-Dwyer et al., patients should be informed not only about the physical effects of the surgical intervention, but also on the possible effects on QOL, psychological well-being (PWB), and daily functioning.[12]

Finally, most studies tend to focus on a specific disease and they do not compare QOL, disability, and PWB among different neurosurgical pathologies.[13],[14] As such, this was the primary motivation for this study, as it is crucial to understand QOL among patients who undergo lumbar microdiscectomy due to the temporal or even permanent nature of associated disabilities.

The current study aimed to assess the impact of lumbar microdiscectomy on patientsí postoperative QOL and it investigated all facets of life to identify the most commonly affected areas. Further, surgical complications and outcomes were assessed for the included patients.


  Patients and Methods Top


Ethics approval was obtained for a records-based, descriptive, cross-sectional study. Total of 97 patients who underwent microscopic lumbar discectomy at the Aseer Central Hospital (ACH) in Southwestern Saudi Arabia during the period from 2015 to 2017, were included. Patients who had documented spinal fractures per their medical files, as well as those who had incomplete medical files, were excluded. No selection bias encountered, as we included all patients with complete data. Patient files were reviewed for data extraction. The extracted data included sociodemographic data such as age, gender, marital status, and education. Patients were asked to complete the HRQoL scale (the EuroQoL 5-Dimension 5-Level [EQ-5D-5 L] QOL questionnaire) over the phone. The EQ-5D-5 L consists of two pages: the EQ-5D-5 L descriptive system (page 2) and the EQ visual analogue scale (page 3). The descriptive system comprises the same five dimensions as the EQ5D-3 L (mobility, self-care, usual activities, pain/discomfort, anxiety/depression); however, each dimension now has five levels: no problems, slight problems, moderate problems, severe problems, and extreme problems.[15]

Statistical analysis

Following data extraction, errors were revised and filtered, and then the data were entered into the Statistical Package for the Social Sciences (SPSS version 21; IBM Corporation, Armonk, NY, USA). All statistical calculations were two tailed and P ≤ 0.05 was considered statistically significant. Descriptive statistics were used to compute frequencies and percentages for all categorical variables. With respect to QOL, scores ranged from 1 point (completely able) to 4 points (completely unable), and then the overall score percentage for each domain was calculated by dividing the actual score by the maximum score for each domain. Higher percentages represented poorer QOL (i.e., an unable person). Any associations between different factors and QOL scores were tested using Chi-square or Fisher's exact tests based on fulfilled assumptions. The included graphs were constructed using Microsoft Excel software (Microsoft Corporation, Redmond, WA, USA).


  Results Top


The study included 97 patients whose ages ranged from 28 to 56 years, with a mean age of 42.6 ± 10.8 years. Nearly 61% of patients were male and 78.4% of all participants were married. Illiteracy was recorded among 17.5% of the patients, while 37.1% were highly educated. Regarding residence, 74.2% of the patients came from the highlands and 54.6% were employed in office work. Further, 21.6% of patients were smokers [Table 1]. The symptoms upon presentation of participants are shown in [Figure 1].
Table 1: Sociodemographic characteristics of patients who underwent lumbar microdiscectomy

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Figure 1: Symptoms recorded by patients undergone lumbar microdiscectomy

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When examining mobility as an aspect of patients' lives, 74.2% of patients had high mobility levels with minimal problems. Regarding self-care, 81.8% of the included patients had no or minimal self-care problems. Further, 72.2% of the patients performed their usual activities with no or minimal limitations. Regarding pain and discomfort, 65.9% of the patients had no or minimal pain, while 82.5% of the patients experienced either no or minimal levels of anxiety and depression [Table 2].
Table 2: Description of quality of EuroQoL 5-dimension 5-level domains among patients who underwent lumbar microdiscectomy

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With respect to the symptoms recorded by the studied patients [Figure 1], low back pain was the most frequently recorded (75.3%), followed by limb pain (50.5%) and numbness (35.1%); bladder and anal sphincter disturbances were the least frequently reported complaints (5.2% and 1.0% of patients, respectively).

[Figure 2] demonstrates the pathology and type of lumbar microdiscectomy recorded among the included patients. About 74% of patients had a spinal lesion at only one level and 88% of the recorded lesions were disc prolapse. As for the types of spinal surgery that patients underwent, 92% underwent discectomy only, while 8% underwent microdiscectomy and laminectomy.
Figure 2: Type of surgery done for patients undergone lumbar microdiscectomy

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In terms of complications, the most frequently reported intraoperative complication was bleeding (9.3%), followed by dural tear (1.0%), cerebrospinal fluid leak (1.0%), and others. The most commonly recorded postoperative complications were wound infection (2.1%) and wound hematoma (1.0%) [Figure 3].
Figure 3: Complications recorded among patients undergone lumbar microdiscectomy

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When relating QOL levels with patient characteristics [Table 3], it was clear that 67.8% of male patients had a significantly higher QOL when compared to 39.5% of females (P < 0.05). As for age, 53.8% of patients aged <30 years had a high QOL compared to 43.2% of those who were over 50 years of age; this difference was not statistically significant. When examining education, 80.6% of patients who were university graduates had a significantly higher QOL when compared to 47.1% of noneducated patients (P < 0.05). When examining postoperative symptoms and their relationship with QOL, 55.9% of patents presented with numbness had a significantly higher QOL when compared to 63.5% of those presented without numbness (P < 0.05). All other symptoms had no significant association with patients' QOL. When exploring surgery type, 59.4% of patients who underwent discectomy had a high QOL compared to 66.7% of those who had undergone laminectomies. These differences were found to be statistically significant.
Table 3: Factors affecting quality of life levels among patients who underwent lumbar microdiscectomy

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  Discussion Top


Nowadays, QOL is gaining increasing importance in both medicine and surgery. Interventions are being assessed in terms of their impact on such areas of functioning as mobility, pain/discomfort, mood, ability to perform daily activities, occupation, social activities, and general life satisfaction. By assessing QOL, we can modify all aspects of patient care and avoid the inconvenient management options while caring for the patient. We can also avoid the expensive costs of diagnosis, treatment, and length of stay in the hospital. Further, we can better understand the efficacy of current management approaches and the final outcomes that affect patients' lives. In fact, developing a new method may be more effective than current management options.

Recently, the EQ-5D-5 L has demonstrated its effectiveness in the assessment of QOL, as it can be self-completed and is easy to understand.[16] In Jordan, Aburuz et al.[17] validated and published an Arabic version of the EQ-5D, which was an easy-to-understand and easy-to-use scale for an Arabic-speaking population.

The EQ-5D-5 L has been tested in more specific populations, such as among adolescents with idiopathic scoliosis; this measure was found to be very reliable in the assessment of QOL in this spinal pathology.[18] In lumbar stenosis in elderly patients, the EQ-5D-5 L has been utilized and it was revealed to be a reliable tool in the assessment of this population.[19]

Few spine-related studies have tested and predicted EQ-5D-5 L values based on other well-recognized scales, and these values were found to exhibit reasonable and satisfactory levels of vicariance.[19],[20] These findings, as well as those from other nonspinal pathology-related studies, reiterate the fact that the EQ-5D-5 L score can be a great alternative when assessing patients' QOL, given the measure's ease of use and comprehension.

Since more studies are now comparing conservative versus surgical treatments in common spinal disorders,[21] our patients need some guidance to navigate what they may regard as contradicting and confusing data, and the solution may rely on QOL assessment results, particularly if they wish to consider surgical options. In our study, we found that patients' QOL is similar to those reported in another major randomized control study;[21],[22] however, a different assessment tool was used in that investigation.

Regarding the strengths of our study, this is the first study to utilize the EQ-5D-5 L to assess QOL in postlumbar discectomy patients. We specifically focused on postsurgical QOL, which is considered to be a big landmark in terms of surgical success and patient satisfaction. Further, the data were obtained from the patients themselves, as well as from their files. Also, we are the first study to use EQ-5D-5 L scores in postspinal surgery patients. Briefly, we are the first to utilize and present a well-validated scoring system in postlumbar discectomy in the English literature, and we have obtained results that were similar to those of major studies in the field that utilized different tools to assess QOL.


  Conclusions Top


The researcher concluded that the majority of patients who underwent lumbar discectomy had a high QOL based on their scores on the EQ-5D-5 L. The best improvements following surgical repair were recorded for self-care, mobility, and psychological status, while the lowest improvements were noted for pain and discomfort. Low back pain was the most prominent postsurgical complaint. Males who were highly educated reported the highest level of QOL, especially if they had microdiscectomy and laminectomy. The researchers recommended that there should be a greater focus on pain-reduction methods for patients who undergo lumbar microdiscectomy, which is vital for performing usual activities. Further prospective study that looks for preoperative and postoperatives' outcomes is recommended.

Strengths and limitations of the study

The major strength is the fact that our study is the first study to use EQ-5D-5 L scores in postspinal surgery and more specific after lumbar microdiscectomy. Furthermore, the study emphasizes the fact that majority of postlumbar microdiscectomy had a good QOL, and the authors proved that by a well-validated questionnaire. In regard to limitations, the sample was moderate in size given that some patients were difficult to contact, as there were changes in their contact information or missing data in their files. In addition, we did not conduct a preoperative assessment, we did not have control group, and we could not reach out to a larger sample population due to the recent electronic archives that were implemented at ACH.

Acknowledgments

We acknowledge all patients participated in the study. English-language editing of this manuscript was provided by Journal Prep Services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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