Preoperative Resilience and Early Postoperative Outcomes following Lumbar Spinal Fusion

Background: Previous studies identified a correlation between preoperative resilience scores and patient reported outcome measures in several surgical subspecialities. No previous studies, to our knowledge, have analyzed preoperative resilience and patient reported outcomes in lumbar spinal fusion.

Methods: Patients undergoing lumbar spinal fusion completed the Brief Resilience Scale (BRS) preoperatively, in addition to measures of disability (Oswestry Disability index [ODI]), quality of life (PROMIS global physical and mental health scales and EuroQol5), and leg and back pain (VAS) at pre- and 3-months postoperatively. The 3-month follow-up was selected due to the association with return to work. Multiple linear regression evaluated relationships between resilience and postoperative changes in outcomes measures, controlling for baseline values and body mass index, age, number of levels fused, and severity of comorbidities.

Results: Ninety-five participants (mean age 58 years, 56% male) completed the BRS preoperatively and outcome measures before and 3 months after lumbar fusion. On average, participants reported significant postoperative improvements on all outcome measures (P < 0.001). Higher preoperative resilience scores related to greater postoperative improvements in back and leg pain, global mental and physical health and EuroQol scores (P < 0.05), after controlling for baseline values and other covariates. Resilience scores did not significantly correlate with postoperative changes in ODI (P > 0.05).

Conclusions: Preoperative resilience is associated with improvement in pain and physical and mental health quality of life during the early postoperative period following lumbar spinal fusion. Additional research is needed to determine if improvements are maintained beyond this interval and whether resilience can be modified to optimize outcomes.