• Owoicho Adogwa, James P Caruso, Cody M Eldridge, Ravinderjit Singh, Sai Chilakapati, Palvasha Deme, Sonja Stutzman, Salah G Aoun, Aanand D Naik, Carlos A Bagley, and Una Makris.
• Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX.
• Spine. 2022 Apr 15; 47 (8): E337-E346.

Study DesignRetrospective.ObjectiveTo investigate the prevalence of decisional regret among older adults undergoing surgery for adult spinal deformity (ASD).Summary Of Background DataAmong older adults (≥65 years old), ASD is a leading cause of disability, with a population prevalence of 60% to 70%. While surgery is beneficial and results in functional improvement, in over 20% of older adults outcomes from surgery are less desirable.MethodsOlder adults with ASD who underwent spinal surgery at a quaternary medical center from January 1, 2016 to March 1, 2019, were enrolled in this study. Patients were categorized into medium/high or low-decisional regret cohorts based on their responses to the Ottawa decision regret questionnaire. Decisional regret assessments were completed 24 months after surgery. The primary outcome measure was prevalence of decisional regret after surgery. Factors associated with high decisional regret were analyzed by multivariate logistic regression.ResultsA total of 155 patients (mean age, 69.5 yrs) met the study inclusion criteria. Overall, 80% agreed that having surgery was the right decision for them, and 77% would make the same choice in future. A total of 21% regretted the choice that they made, and 21% responded that surgery caused them harm. Comparing patient cohorts reporting medium/high- versus low-decisional regret, there were no differences in baseline demographics, comorbidities, invasiveness of surgery, length of stay, discharge disposition, or extent of functional improvement 12-months after surgery. After adjusting for sex, American Society of Anesthesiologists score, invasiveness of surgery, and presence of a postoperative complication, older adults with preoperative depression had a 4.0 fold increased odds of high-decisional regret (P  = 0.04). Change in health related quality of life measures were similar between all groups at 12-months after surgery.ConclusionWhile the majority of older adults were appropriately counseled and satisfied with their decision, one-in-five older adults regret their decision to undergo surgery. Preoperative depression was associated with medium/high decisional regret on multivariate analysis.Level of Evidence: 4.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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