Trends in the use of patient-reported outcome instruments in neurosurgical adult thoracolumbar deformity and degenerative disease literature

Do readmissions and reoperations adversely affect patient-reported outcomes following complex adult spinal deformity surgery at a minimum 2 years postoperative?

BACKGROUND

Unplanned readmissions and reoperations are known to be associated with undesirable costs and potentially inferior outcomes in complex adult spinal deformity (ASD) surgery. A paucity of literature exists on the impact of readmissions/reoperations on patient-reported outcomes (PRO) in this population.

METHODS

Consecutively treated adult patients who underwent complex ASD surgery at a single institution from 2015-2018 and minimum 2-year follow-up were studied. Demographics/comorbidities, operative factors, inpatient complications, and postoperative clinical and patient-reported outcomes (SRS-22r, ODI) were assessed for those with and without readmission/reoperation.

RESULTS

175 patients (72% female, mean age 52.6 ± 16.4) were included. Mean total instrumented/fused levels was 13.3 ± 4.1, range 6-25. The readmission and reoperation rates were 16.6% and 12%, respectively. The two most common causes of reoperation were pseudarthrosis (5.1%) and PJK (4.0%). Predictors for readmission within 2 years following surgery included pulmonary, cardiac, depression and gastrointestinal comorbidities, along with performance of a VCR, and TLIF. At 2 years postoperatively, those who required a readmission/reoperation had significant increases in SRS and reductions in ODI compared to 1-year and preoperative values. Inpatient complications did not negatively impact 2-year PRO's. The 2-year MCID in PROs was not significantly different between those with and without readmission/reoperation.

CONCLUSION

Complex ASD surgery carries risk, but the vast majority can achieve MCID (SRS-86.4%, ODI-68.2%) in PROs by 2 years. Importantly, even those with inpatient complications and those who required unplanned readmission/reoperation can improve PROs by 2-year follow-up compared to preoperative baseline and 1-year follow-up and achieve similar improvements compared to those who did not require a readmission.

LEVEL OF EVIDENCE

III.

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

STUDY DESIGN

Retrospective case series.

OBJECTIVE

Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes.

METHODS

We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries.

RESULTS

Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months = 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months = 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (-2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%).

CONCLUSIONS

Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.

Comparing functioning in spinal cord injury and in chronic spinal pain with two ICF-based instruments: WHODAS 2.0 and the WHO minimal generic data set covering functioning and health

OBJECTIVE

To investigate whether the two briefest validated ICF-based (International Classification of Functioning, Disability and Health) tools can detect differences between different spinal conditions.

DESIGN

Cross-sectional study.

SETTING

University hospital rehabilitation clinic.

SUBJECTS

A total of 84 patients with spinal cord injury and 81 with chronic spinal pain.

MAIN MEASURES

Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 ((World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health.

FINDINGS

The two measures used showed severe disability in both patient populations, those with spinal cord injury (mean age 47.5 years, SD 13.2) and those with chronic spinal pain (mean age 47.2 years, SD 9.5), WHODAS patient sum being 18.4 (SD 9.6) versus 22.0 (SD 9.0), P < 0.05, and the WHO generic data set 15.6 (SD 4.4) versus 14.2 (SD 3.7), P < 0.01, respectively. Correlations between patient and proxy ratings and between the two disability scales were mostly strong. Severe restrictions were found in the working ability of both the populations, in mobility of patients with spinal cord injury and in pain function of patients with chronic spinal pain. In this tertiary clinic patient population, patients with spinal pain perceived more problems in emotional and cognitive functions, and in participation than patients with spinal cord injury.

CONCLUSIONS

Both scales were able to find differences between two patient populations with severe disability.