Exploring the preoperative experiences of patients in a disruptive recovery trajectory following lumbar spinal fusion surgery: a secondary analysis of a qualitative study.

BACKGROUND: Following lumbar spinal fusion surgery (LSFS), some patients experienced a disruptive recovery, characterized by persistent pain, functional limitations, and difficulty resuming life. However, little is known about their preoperative experiences. OBJECTIVE: To explore the preoperative experiences of patients in disruptive recovery following LSFS. METHODS: A secondary analysis was performed on qualitative data aligned with the Standards for Reporting Qualitative Research. Participants from four UK surgery centers underwent two semi-structured interviews following LSFS and completed weekly diaries. Three recovery trajectories emerged from the first month's diaries: meaningful, progressive, and disruptive. Transcripts from the interviews with participants in disruptive recovery, conducted two weeks following LSFS, were analyzed using interpretative phenomenological analysis, focusing on their preoperative experiences. Two independent researchers defined themes through an iterative process. Collaborative analytical process and reflexive dialogs were used to enhance trustworthiness, with ideography maintained through constant data comparison and discussion. RESULTS: Seven themes were interpreted from eight participants. Patients' experiences while living with back problems captured in "compounded struggles" and "multidimensional effects of back problems." Their experiences with the treatment process and the factors influencing their decision to undergo surgery were described in "experiences in the treatment process" and "journey to surgery." Their experiences before surgery were identified in "understanding surgery: awareness and expectations," "psychological burden," and "preparation for surgery." CONCLUSIONS: Findings revealed complex patient challenges, diverse treatment interactions, long waits, multifactorial surgery decisions, with identified preoperative gaps, informing future research of patient needs to improve LSFS outcomes.