PMID- 38420655
OWN - NLM
STAT- Publisher
LR  - 20240229
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
DP  - 2024 Feb 29
TI  - Using Oswestry Disability Index as a Preoperative Surgical Eligibility Criterion 
      for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease.
LID - 10.1097/BRS.0000000000004972 [doi]
AB  - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate how preoperative 
      Oswestry Disability Index (ODI) thresholds might affect minimal clinically 
      important difference (MCID) achievement following lumbar fusion. SUMMARY OF 
      BACKGROUND DATA: As payers invest in alternative payment models, some are 
      suggesting threshold cutoffs of patient reported outcomes (PROMs) in 
      reimbursement approvals for orthopedic procedures. The feasibility of this has 
      not been investigated in spine surgery. MATERIALS/METHODS: We included all adult 
      patients undergoing 1-3 level primary lumbar fusion at a single urban tertiary 
      academic center from 2014-2020. ODI was collected preoperatively and one-year 
      postoperatively. We implemented theoretical threshold cutoffs at increments of 
      10. MCID was set at 14.3. The percent of patients meeting MCID were determined 
      among patients "approved" or "denied" at each threshold. At each threshold, the 
      positive predictive value (PPV) for MCID attainment was calculated. RESULTS: A 
      total 1,368 patients were included and 62.4% (N=364) achieved MCID. As the ODI 
      thresholds increased, a greater percent of patients in each group reached the 
      MCID. At the lowest ODI threshold, 6.58% (N=90) of patients would be denied, 
      rising to 20.2%, 39.5%, 58.4%, 79.9%, and 91.4% at ODI thresholds of 30, 40, 50, 
      60, and 70, respectively. The PPV increased from 0.072 among patients with ODI>20 
      to 0.919 at ODI>70. The number of patients denied a clinical improvement in the 
      denied category per patient achieving the MCID increased at each threshold 
      (ODI>20: 1.96; ODI>30: 2.40; ODI>40: 2.75; ODI>50: 3.03; ODI>60: 3.54; ODI>70: 
      3.75). CONCLUSION: Patients with poorer preoperative ODI are significantly more 
      likely to achieve MCID following lumbar spine fusion at all ODI thresholds. 
      Setting a preoperative ODI threshold for surgical eligibility will restrict 
      access to patients who may benefit from spine fusion, despite ODI>20 
      demonstrating the lowest predictive value for MCID achievement.
CI  - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Issa, Tariq Z
AU  - Issa TZ
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
FAU - Haider, Ameer A
AU  - Haider AA
AD  - Department of Orthopaedic Surgery, Washington University School of Medicine, St. 
      Louis, MO.
FAU - Lambrechts, Mark J
AU  - Lambrechts MJ
AD  - Department of Orthopaedic Surgery, Washington University School of Medicine, St. 
      Louis, MO.
FAU - Sherman, Matthew B
AU  - Sherman MB
AD  - Department of Orthopaedic Surgery, Washington University School of Medicine, St. 
      Louis, MO.
FAU - Canseco, Jose A
AU  - Canseco JA
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
FAU - Vaccaro, Alexander R
AU  - Vaccaro AR
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
FAU - Schroeder, Gregory D
AU  - Schroeder GD
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
FAU - Kepler, Christopher K
AU  - Kepler CK
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
FAU - Hilibrand, Alan S
AU  - Hilibrand AS
AD  - Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson 
      University, Philadelphia, PA.
LA  - eng
PT  - Journal Article
DEP - 20240229
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
COIS- Conflicts of Interest and Source of Funding: The authors, their immediate family, 
      and any research foundation with which they are affiliated did not receive any 
      financial payments or other benefits from any commercial entity related to the 
      subject of this article. There are no relevant disclosures.
EDAT- 2024/02/29 06:43
MHDA- 2024/02/29 06:43
CRDT- 2024/02/29 04:16
PHST- 2023/12/26 00:00 [received]
PHST- 2024/02/14 00:00 [accepted]
PHST- 2024/02/29 06:43 [medline]
PHST- 2024/02/29 06:43 [pubmed]
PHST- 2024/02/29 04:16 [entrez]
AID - 00007632-990000000-00606 [pii]
AID - 10.1097/BRS.0000000000004972 [doi]
PST - aheadofprint
SO  - Spine (Phila Pa 1976). 2024 Feb 29. doi: 10.1097/BRS.0000000000004972.