PMID- 32779122 OWN - NLM STAT- MEDLINE DCOM- 20211118 LR - 20211118 IS - 2212-1358 (Electronic) IS - 2212-134X (Linking) VI - 9 IP - 1 DP - 2021 Jan TI - Preoperative patient-reported outcome score thresholds predict the likelihood of reaching MCID with surgical correction of adult spinal deformity. PG - 207-219 LID - 10.1007/s43390-020-00171-9 [doi] AB - BACKGROUND CONTEXT: Preoperative (pre-op) identification of patients likely to achieve a clinically meaningful improvement following surgery for adult spinal deformity (ASD) is critical, especially given the substantial cost and comorbidity associated with surgery. Even though pain is a known indication for surgical ASD correction, we are not aware of established thresholds for baseline pain and function to guide which patients have a higher likelihood of improvement with corrective surgery. PURPOSE: We aimed to establish pre-op patient-reported outcome measure (PROM) thresholds to identify patients likely to improve by at least one minimum clinically important difference (MCID) with surgery for ASD. STUDY DESIGN: This is a retrospective cohort study using prospectively collected data. PATIENT SAMPLE: We reviewed 172 adult patients' charts who underwent corrective surgery for spinal deformity. OUTCOME MEASURES: Included measures were the Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22). Our primary outcome of interest was improvement by at least one MCID on the ODI and SRS-22 at 2 years after surgery. METHODS: As part of usual care, the VAS, ODI, and SRS-22 were collected pre-op and re-administered at 1, 2, and 5 years after surgery. MCIDs were calculated using a distribution-based method. Determining significant predictors of MCID at two years was accomplished by Firth bias corrected logistic regression models. Significance of predictors was determined by Profile Likelihood Chi-square. We performed a Youden analysis to determine thresholds for the strongest pre-op predictors. RESULTS: At year two, 118 patients (83%) reached MCID for the SRS and 127 (75%) for the ODI. Lower pre-op SRS overall, lower pre-op SRS pain, and higher pre-op SRS function predicted a higher likelihood of reaching MCID on the overall SRS (p < 0.05). Higher pre-op ODI, lower SRS pain and self-image, and higher SRS overall predicted a higher likelihood of reaching MCID on the ODI (p < 0.05). An ODI threshold of 29 predicted reaching MCID with a sensitivity of 0.89 and a specificity of 0.64 (AUC = 0.7813). An SRS threshold of 3.89 predicted reaching MCID with a sensitivity of 0.93 and specificity of 0.68 (AUC = 0.8024). CONCLUSIONS: We identified useful thresholds for ODI and SRS-22 with acceptable predictive ability for improvement with surgery for ASD. Pre-op ODI, SRS, and multiple SRS subscores are predictive of meaningful improvement on the ODI and/or SRS at 2 years following corrective surgery for spinal deformity. These results highlight the usefulness of PROMs in pre-op shared decision-making. FAU - Leyton-Mange, Andrea AU - Leyton-Mange A AD - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas At Austin, 1701 Trinity Street Stop Z0800, Austin, TX, 78712, USA. FAU - Truumees, Eeric AU - Truumees E AD - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas At Austin, 1701 Trinity Street Stop Z0800, Austin, TX, 78712, USA. ETruumees@ascension.org. AD - Ascension Texas Spine and Scoliosis, 1600 West 38th Street Suite 200, Austin, TX, 78731, USA. ETruumees@ascension.org. FAU - Bozic, Kevin J AU - Bozic KJ AD - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas At Austin, 1701 Trinity Street Stop Z0800, Austin, TX, 78712, USA. FAU - Singh, Devender AU - Singh D AD - Ascension Texas Spine and Scoliosis, 1600 West 38th Street Suite 200, Austin, TX, 78731, USA. FAU - Liu, Tiffany C AU - Liu TC AD - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas At Austin, 1701 Trinity Street Stop Z0800, Austin, TX, 78712, USA. FAU - Stokes, John K AU - Stokes JK AD - Ascension Texas Spine and Scoliosis, 1600 West 38th Street Suite 200, Austin, TX, 78731, USA. FAU - Mahometa, Michael J AU - Mahometa MJ AD - Department of Statistics and Data Science, The University of Texas At Austin, 2317 Speedway, Austin, TX, 78712, USA. FAU - Geck, Matthew J AU - Geck MJ AD - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas At Austin, 1701 Trinity Street Stop Z0800, Austin, TX, 78712, USA. AD - Ascension Texas Spine and Scoliosis, 1600 West 38th Street Suite 200, Austin, TX, 78731, USA. LA - eng PT - Journal Article DEP - 20200810 PL - England TA - Spine Deform JT - Spine deformity JID - 101603979 SB - IM MH - Adult MH - Humans MH - Minimal Clinically Important Difference MH - Patient Reported Outcome Measures MH - *Quality of Life MH - Retrospective Studies MH - *Scoliosis/surgery OTO - NOTNLM OT - Adult spinal deformity OT - Oswestry disability index OT - Patient-reported outcome measures OT - Predictive model OT - Risk stratification OT - SRS-22 OT - Spine surgery OT - VAS EDAT- 2020/08/12 06:00 MHDA- 2021/11/19 06:00 CRDT- 2020/08/12 06:00 PHST- 2020/01/23 00:00 [received] PHST- 2020/07/20 00:00 [accepted] PHST- 2020/08/12 06:00 [pubmed] PHST- 2021/11/19 06:00 [medline] PHST- 2020/08/12 06:00 [entrez] AID - 10.1007/s43390-020-00171-9 [pii] AID - 10.1007/s43390-020-00171-9 [doi] PST - ppublish SO - Spine Deform. 2021 Jan;9(1):207-219. doi: 10.1007/s43390-020-00171-9. Epub 2020 Aug 10.