FACTORS ASSOCIATED WITH PREOPERATIVE HEALTH-RELATED QUALITY OF LIFE IN PATIENTSUNDERGOING SURGERYFOR DEGENERATIVE LUMBAR SPINE CONDITIONS: A CROSS-SECTIONAL EQ-5D STUDYIN A MULTI-ETHNIC ASIAN POPULATION
Author(s)
Xun Li, BSc (Hons), MSc1, Alex Teo2, Annushiah Vasan Thakumar, BSc, PhD3, Nan Luo, PhD4, Hwee Weng Dennis Hey, MBBS, MRCS, MMED, MCI, FRCSEd5, Ling Jie Cheng, BSN (Hons), MPH, PhD, RN6;
1School of Engineering, Computing, and Mathematics, Oxford Brookes University, Oxford, United Kingdom, 2Singapore, 3School of Pharmacy, Faculty of Health & Medical Sciences, Taylor’s University, Subang Jaya, Malaysia, 4National University of Singapore, Singapore, Singapore, 5Division of Spine Surgery, Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore, 6National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
1School of Engineering, Computing, and Mathematics, Oxford Brookes University, Oxford, United Kingdom, 2Singapore, 3School of Pharmacy, Faculty of Health & Medical Sciences, Taylor’s University, Subang Jaya, Malaysia, 4National University of Singapore, Singapore, Singapore, 5Division of Spine Surgery, Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore, 6National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
OBJECTIVES: Degenerative lumbar spine conditions impose substantial global disease burden. Understanding factors associated with health-related quality of life (HRQoL) may inform preoperative assessment and patient-centred care; however, evidence on EQ-5D predictors in Asian surgical populations remains limited. This study examined socio-demographic, clinical, and healthcare factors associated with preoperative HRQoL among patients undergoing surgery for degenerative lumbar spine conditions in Singapore.
METHODS: This cross-sectional study analysed baseline data from the Spine PROM Surgery Registry, including 1,194 patients with degenerative disc disease, prolapsed disc, spondylolisthesis, or spinal stenosis scheduled for surgery between 2017-2022. HRQoL was assessed using the EQ-5D-3L, with utilities cross-walked to EQ-5D-5L. Hierarchical linear regression examined associations across socio-demographic, clinical, and healthcare/lifestyle factors. Multivariable logistic regression identified predictors of reporting problems across EQ-5D dimensions.
RESULTS: Participants had a mean age of 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities (84.3%) were most affected, followed by mobility (74.1%), anxiety/depression (53.1%), and self-care (38.3%). In fully adjusted models, non-outpatient admission (i.e., non-elective presentation at registry recruitment, via the emergency department or direct inpatient admission; β=−0.37), non-Chinese ethnicity (β=−0.08 to −0.12), secondary education (β=−0.15), and trauma history (β=−0.11) were associated with lower HRQoL, while female sex was associated with higher HRQoL (β=0.06). In dimension-specific analyses, secondary education predicted higher odds of problems across mobility (OR=2.72), self-care (OR=1.87), usual activities (OR=1.80), and anxiety/depression (OR=1.97). Non-outpatient admission predicted self-care problems (OR=2.98); comorbidity predicted usual activity problems (OR=1.89). Female sex was associated with lower odds of pain/discomfort (OR=0.53) and anxiety/depression (OR=0.71).
CONCLUSIONS: Preoperative HRQoL was substantially impaired among surgical patients. Admission source, ethnicity, and education showed consistent associations, while predictors varied across dimensions. These findings support preoperative risk stratification and health technology evaluation in musculoskeletal care.
METHODS: This cross-sectional study analysed baseline data from the Spine PROM Surgery Registry, including 1,194 patients with degenerative disc disease, prolapsed disc, spondylolisthesis, or spinal stenosis scheduled for surgery between 2017-2022. HRQoL was assessed using the EQ-5D-3L, with utilities cross-walked to EQ-5D-5L. Hierarchical linear regression examined associations across socio-demographic, clinical, and healthcare/lifestyle factors. Multivariable logistic regression identified predictors of reporting problems across EQ-5D dimensions.
RESULTS: Participants had a mean age of 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities (84.3%) were most affected, followed by mobility (74.1%), anxiety/depression (53.1%), and self-care (38.3%). In fully adjusted models, non-outpatient admission (i.e., non-elective presentation at registry recruitment, via the emergency department or direct inpatient admission; β=−0.37), non-Chinese ethnicity (β=−0.08 to −0.12), secondary education (β=−0.15), and trauma history (β=−0.11) were associated with lower HRQoL, while female sex was associated with higher HRQoL (β=0.06). In dimension-specific analyses, secondary education predicted higher odds of problems across mobility (OR=2.72), self-care (OR=1.87), usual activities (OR=1.80), and anxiety/depression (OR=1.97). Non-outpatient admission predicted self-care problems (OR=2.98); comorbidity predicted usual activity problems (OR=1.89). Female sex was associated with lower odds of pain/discomfort (OR=0.53) and anxiety/depression (OR=0.71).
CONCLUSIONS: Preoperative HRQoL was substantially impaired among surgical patients. Admission source, ethnicity, and education showed consistent associations, while predictors varied across dimensions. These findings support preoperative risk stratification and health technology evaluation in musculoskeletal care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH106
Topic
Epidemiology & Public Health
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)