PMID- 29624128 OWN - NLM STAT- MEDLINE DCOM- 20190528 LR - 20190528 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 29 IP - 1 DP - 2018 Jul TI - The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity. PG - 68-74 LID - 2017.10.SPINE17830 [pii] LID - 10.3171/2017.10.SPINE17830 [doi] AB - OBJECTIVE Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity. METHODS This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively. RESULTS A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001). CONCLUSIONS The authors' results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients' preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients. FAU - Raad, Micheal AU - Raad M AD - Departments of1Orthopaedic Surgery and. FAU - Neuman, Brian J AU - Neuman BJ AD - Departments of1Orthopaedic Surgery and. FAU - Jain, Amit AU - Jain A AD - Departments of1Orthopaedic Surgery and. FAU - Hassanzadeh, Hamid AU - Hassanzadeh H AD - 2Orthopaedic Surgery and. FAU - Passias, Peter G AU - Passias PG AD - 3Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York. FAU - Klineberg, Eric AU - Klineberg E AD - 4Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento. FAU - Mundis, Gregory M AU - Mundis GM AD - 5San Diego Center for Spinal Disorders, La Jolla, California. FAU - Protopsaltis, Themistocles S AU - Protopsaltis TS AD - 3Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York. FAU - Miller, Emily K AU - Miller EK AD - Departments of1Orthopaedic Surgery and. FAU - Smith, Justin S AU - Smith JS AD - 6Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Lafage, Virginie AU - Lafage V AD - 7Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. FAU - Hamilton, D Kojo AU - Hamilton DK AD - 8Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and. FAU - Bess, Shay AU - Bess S AD - 9Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado. FAU - Kebaish, Khaled M AU - Kebaish KM AD - Departments of1Orthopaedic Surgery and. FAU - Sciubba, Daniel M AU - Sciubba DM AD - 10Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of. CN - International Spine Study Group LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180406 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Comorbidity MH - *Exercise MH - Female MH - Humans MH - Length of Stay MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - Retrospective Studies MH - Sedentary Behavior MH - Self Report MH - Severity of Illness Index MH - Spinal Curvatures/*diagnosis/epidemiology/physiopathology/*surgery MH - Spine/diagnostic imaging/surgery MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - ASD = adult spinal deformity OT - CCI = Charlson Comorbidity Index OT - HRQOL = health-related quality of life OT - IRR = incidence risk ratio OT - LL = lumbar lordosis OT - LOS = length of stay OT - MCID = minimum clinically important difference OT - PCS = Physical Component Summary OT - PI = pelvic incidence OT - PT = pelvic tilt OT - Physical Component Summary OT - SRS-22r = Scoliosis Research Society-22r Patient Questionnaire OT - SVA = sagittal vertical axis OT - Scoliosis Research Society-22r Patient Questionnaire OT - adult spinal deformity OT - patient stratification OT - preoperative activity EDAT- 2018/04/07 06:00 MHDA- 2019/05/29 06:00 CRDT- 2018/04/07 06:00 PHST- 2018/04/07 06:00 [pubmed] PHST- 2019/05/29 06:00 [medline] PHST- 2018/04/07 06:00 [entrez] AID - 2017.10.SPINE17830 [pii] AID - 10.3171/2017.10.SPINE17830 [doi] PST - ppublish SO - J Neurosurg Spine. 2018 Jul;29(1):68-74. doi: 10.3171/2017.10.SPINE17830. Epub 2018 Apr 6.