PMID- 26621415
OWN - NLM
STAT- MEDLINE
DCOM- 20160913
LR  - 20151201
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 39
IP  - 6
DP  - 2015 Dec
TI  - Patient-reported outcomes 3 months after spine surgery: is it an accurate 
      predictor of 12-month outcome in real-world registry platforms?
PG  - E17
LID - 10.3171/2015.9.FOCUS15356 [doi]
AB  - OBJECT The health care landscape is rapidly shifting to incentivize quality of 
      care rather than quantity of care. Quality and outcomes registry platforms lie at 
      the center of all emerging evidence-driven reform models and will be used to 
      inform decision makers in health care delivery. Obtaining real-world registry 
      outcomes data from patients 12 months after spine surgery remains a challenge. 
      The authors set out to determine whether 3-month patient-reported outcomes 
      accurately predict 12-month outcomes and, hence, whether 3-month measurement 
      systems suffice to identify effective versus noneffective spine care. METHODS All 
      patients undergoing lumbar spine surgery for degenerative disease at a single 
      medical institution over a 2-year period were enrolled in a prospective 
      longitudinal registry. Patient-reported outcome instruments (numeric rating scale 
      [NRS], Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12], 
      EQ-5D, and the Zung Self-Rating Depression Scale) were recorded prospectively at 
      baseline and at 3 months and 12 months after surgery. Linear regression was 
      performed to determine the independent association of 3- and 12-month outcome. 
      Receiver operating characteristic (ROC) curve analysis was performed to determine 
      whether improvement in general health state (EQ-5D) and disability (ODI) at 3 
      months accurately predicted improvement and achievement of minimum clinical 
      important difference (MCID) at 12 months. RESULTS A total of 593 patients 
      undergoing elective lumbar surgery were included in the study. There was a 
      significant correlation between 3-month and 12-month EQ-5D (r = 0.71; p < 0.0001) 
      and ODI (r = 0.70; p < 0.0001); however, the authors observed a sizable 
      discrepancy in achievement of a clinically significant improvement (MCID) 
      threshold at 3 versus 12 months on an individual patient level. For postoperative 
      disability (ODI), 11.5% of patients who achieved an MCID threshold at 3 months 
      dropped below this threshold at 12 months; 10.5% of patients who did not meet the 
      MCID threshold at 3 months continued to improve and ultimately surpassed the MCID 
      threshold at 12 months. For ODI, achieving MCID at 3 months accurately predicted 
      12-month MCID with only 62.6% specificity and 86.8% sensitivity. For 
      postoperative health utility (EQ-5D), 8.5% of patients lost an MCID threshold 
      improvement from 3 months to 12 months, while 4.0% gained the MCID threshold 
      between 3 and 12 months postoperatively. For EQ-5D (quality-adjusted life years), 
      achieving MCID at 3 months accurately predicted 12-month MCID with only 87.7% 
      specificity and 87.2% sensitivity. CONCLUSIONS In a prospective registry, 
      patient-reported measures of treatment effectiveness obtained at 3 months 
      correlated with 12-month measures overall in aggregate, but did not reliably 
      predict 12-month outcome at the patient level. Many patients who do not benefit 
      from surgery by 3 months do so by 12 months, and, conversely, many patients 
      reporting meaningful improvement by 3 months report loss of benefit at 12 months. 
      Prospective longitudinal spine outcomes registries need to span at least 12 
      months to identify effective versus noneffective patient care.
FAU - Parker, Scott L
AU  - Parker SL
AD  - Departments of 1 Neurological Surgery and.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
FAU - Godil, Saniya S
AU  - Godil SS
AD  - Departments of 1 Neurological Surgery and.
FAU - Devin, Clinton J
AU  - Devin CJ
AD  - Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; 
      and.
FAU - McGirt, Matthew J
AU  - McGirt MJ
AD  - Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - *Patient Outcome Assessment
MH  - Patient Satisfaction
MH  - Postoperative Complications/*etiology
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Quality-Adjusted Life Years
MH  - *Registries
MH  - Spinal Cord Injuries/*surgery
MH  - Spine/*surgery
MH  - Surveys and Questionnaires
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ASA = American Society of Anesthesiologists
OT  - MCID = minimum clinical important difference
OT  - ODI = Oswestry Disability Index
OT  - PRO = patient-reported outcome
OT  - ROC = receiver operating characteristic
OT  - SF-12 = 12-Item Short Form Health Survey
OT  - VSR = Vanderbilt Spine Registry
OT  - outcomes
OT  - registry science
OT  - spine
EDAT- 2015/12/02 06:00
MHDA- 2016/09/14 06:00
CRDT- 2015/12/02 06:00
PHST- 2015/12/02 06:00 [entrez]
PHST- 2015/12/02 06:00 [pubmed]
PHST- 2016/09/14 06:00 [medline]
AID - 10.3171/2015.9.FOCUS15356 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2015 Dec;39(6):E17. doi: 10.3171/2015.9.FOCUS15356.