A Standardized Perioperative Care Program and Postoperative Pain, Disability, and Knowledge Among Patients Undergoing Lumbar Spine Surgery in Erbil, Iraq: A Non-Randomized Controlled Study.

BACKGROUND AND AIM: Patients recovering from lumbar spine surgery frequently report persistent pain, functional limitation, and limited understanding of postoperative self-care. This study examined whether participation in a standardized perioperative care program was associated with differences in pain, functional disability, and patient knowledge at 2 months, compared with routine hospital care, among adults undergoing elective lumbar spine surgery in Erbil, Iraq. METHOD: This was a non-randomized (quasi-experimental) controlled study with two parallel groups and pre-post assessment, conducted between September 29, 2024 and April 25, 2025 in the Neurosurgery Unit of Hawler Teaching Hospital. Participants were recruited by purposive sampling and allocated non-randomly by admission cohort; groups were matched on surgery type and key sociodemographic characteristics. Reporting follows the TREND statement for non-randomized evaluations and the TIDieR checklist for intervention description. Outcomes were pain (Universal Pain Assessment Tool, 0-10), functional disability (Oswestry Disability Index, reported throughout on the 0%-100% scale), and knowledge (36-item researcher-developed questionnaire, scaled 0-100). The primary analysis was the between-group difference in change from baseline, estimated by analysis of covariance adjusted for the baseline outcome value and pre-specified covariates and confirmed by a linear mixed model. Responder, hierarchical-regression, and mediation analyses were pre-specified as exploratory and non-causal. RESULTS: Seventy patients (35 per group) completed the study with no loss to follow-up. Groups were comparable at baseline (all p > 0.05). At 2 months, the intervention group reported lower pain (median 0 [IQR 0-2] vs. 5 [3-7]; p < 0.001), lower disability (ODI 4% [2-6] vs. 46% [30-68]; p < 0.001), and higher knowledge (69 [67-70] vs. 41 [40-46]; p < 0.001). The between-group differences in mean change from baseline favored the program for pain (- 3.58 points), disability (- 44.2 percentage points), and knowledge (+ 25.3 points). In exploratory hierarchical regression, program participation showed the largest standardized coefficient for treatment response (β = 0.58, p < 0.01), with the full model accounting for 69% of the variance; these estimates are associative and are not adjusted for unmeasured confounding. CONCLUSIONS: Participation in an intensive, structured perioperative care program was associated with substantially better self-reported pain, disability, and knowledge at 2 months in this selected single-center cohort. Because allocation was not randomized and the program involved considerably greater professional contact than routine care, these findings describe an association rather than a causal effect, and require confirmation in randomized, multicentre trials with longer follow-up. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07459985), registered 04/03/2026 (retrospectively registered; see Section 2.13).