Lifestyle-Related Chronic Diseases and Low Back Pain: Patient-Reported Physical and Mental Health and Early Post-Operative Outcomes

Objective To evaluate cumulative lifestyle-related chronic diseases and self-reported physical and mental health in low back pain (LBP) patients presenting to physiatrists and spine surgeons, and to assess outcomes following spine surgery in patients with and without lifestyle-related chronic disease(s). Design This retrospective study included 4444 patients presenting for evaluation of LBP with physiatrists (n = 3282/4444) or spine surgeons (n = 1162/4444) from 4/1/2019-7/1/2021. Lifestyle-related chronic diseases and PROMIS-10 scores were collected. Length-of-stay (LOS), post-operative events, and persistent post-operative pain within 3 months were collected for surgical patients. Results 60.8% (n = 2704/4444) of patients had lifestyle-related chronic diseases; overweight/obesity was most common (56.8% [n = 2131/3755]). Patients evaluated by spine surgeons had more lifestyle-related chronic diseases than those evaluated by physiatrists. Increasing numbers of lifestyle-related chronic disease were associated with lower PROMIS-10 physical and mental health scores ( P < .001). For surgical patients, LOS was greater for increasing numbers of lifestyle-related chronic diseases ( P = .008). Post-operative events and persistent pain rates were similar in patients with and without lifestyle-related chronic disease. Conclusion Lifestyle-related chronic diseases were common in this cohort and more prevalent in patients evaluated by spine surgeons, highlighting the need for pre-surgical health optimization. Future work should prospectively investigate lifestyle metrics, patient-reported outcomes, and post-operative events following standardized lifestyle medicine program implementation.