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Association Between Age and Short-Term Patient Reported Pain Scores After Complex Spinal Fusion for Adult Deformity Correction: Is Perception of Pain Different?

OBJECTIVE : Complex spinal deformities requiring ≥5 fusion levels is challenging, and significantly impacts the quality of life for the patients. Patient reported pain scores are becoming increasingly important as it sheds insight into the patient’s perception of health stat, as well as serving as a proxy of satisfaction for patients with spine deformity undergoing corrective surgery. However, with an aging population, the impact of age on perception of pain before and after undergoing complex deformity correction is understudied. The aim of this study was to evaluate whether there was an association between age and patient-reported pain scores after complex spinal fusions. METHODS: The medical records of 92 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (≥5 levels) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. Patients were grouped by age: young (<65 years old) and older (≥65 years old). We identified 43 (46.7%) patients ≥65 years old and 49 (53.3%) <65 years old (Elderly: n = 43 vs. Young: n = 49). Patient demographics, comorbidities, intraoperative and postoperative complication rates were collected for each patient. Inpatient patient-reported pain scores and ambulatory status were also collected. The primary outcome of this study was patient-reported pain scores. RESULTS: Patient demographics and comorbidities were slightly different between both cohorts, with the Elderly cohort having a greater proportion of patients with hypertension, hyperlipidemia, and osteoarthritis, Table 1 . The median number of fusion levels operated, length of surgery, estimated blood loss, and complication rates were similar between both cohorts, Table 2 . Moreover, the post-operative complication profiles between the cohorts were also similar, except for the Elderly having a higher rate of post-operative delirium (16.3% vs. 0.0%), Table . Baseline (p = 0.1885), First-(p = 0.3331) and Last-(p = 0.1990) post-operative patient reported pain scores were similar between cohorts, Table 4 . However, the Elderly cohort trended to have a greater reduction of pain from baseline to Last pain score, compared to the Young cohort (Elderly: -2.4 ± 4.1 vs. Young: -0.69 ± 4.5, p = 0.0556 ) , Table 4 . While ambulation immediately before discharge was similar in both groups, the Elderly cohort had significantly fewer ambulatory steps on the first post-operative ambulatory day compared to Young cohort (Elderly: 40.2 ± 63.4 vs. Young: 106.0 ± 134.6, p = 0.0042 ), Table 4. CONCLUSIONS: Our study suggests that age may have an impact in patient perception of pain and improvement after complex spinal fusions (≥5 levels). Consideration of patients’ age may facilitate tailored pain management and physical therapy regimens in deformity patients undergoing correction surgery.