Preoperative Resilience and Improvement in Patient-Reported Outcomes After Lumbar Spinal Fusion

Background Currently, it is incompletely understood how pre-operative resilience affects 1-year post-operative outcomes following lumbar spinal fusion. Methods Patients undergoing open lumbar spinal fusion at a single-center institution were identified between November 2019 to September 2022. Pre-operative resilience was assessed using the Brief Resilience Scale (BRS). Demographic data at baseline including age, gender, comorbidities, and BMI was extracted. Patient reported outcome measures including ODI, PROMIS Global Physical Health (GPH), PROMIS Global Mental Health (GMH), and EuroQol5 scores were collected before the surgery and at 3-months and 1-year post-operatively. Bivariate correlation was conducted between BRS scores and outcome measures at 3-months and 1-year post-operatively. Results 93 patients had baseline and 1-year outcome data. Compared to patients with high resilience, patients in the low resilience group had a higher percentage of females (69.4% vs 43.9%, p=0.02), a higher BMI (32.7 vs 30.1, p=0.03), and lower preoperative GPH (35.8 vs 38.9, p=0.045), GMH (42.2 vs 49.2, p<0.001), and EuroQol scores (0.56 vs 0.61, p=0.01). At 3-months post-operatively, resilience was moderately correlated with GMH (r=0.39) and EuroQol (r=0.32). Similarly, at 1 year post-operatively, resilience was moderately correlated with GMH (r=0.33), and EuroQol (r=0.34). Comparable results were seen in multivariable regression analysis controlling for age, gender, number of levels fused, BMI, CCI, procedure, anxiety/depression, and complications. Conclusion Low pre-operative resilience can negatively affect patient reported outcomes 1-year after lumbar spinal fusion. Resiliency is a potentially modifiable risk factor, and surgeons should consider targeted interventions for at-risk patient groups.