Creating value in spine surgery: using patient reported outcomes to compare the short-term impact of different orthopedic surgical procedures.
Adult
Anterior Cruciate Ligament Injuries
/ complications
Anterior Cruciate Ligament Reconstruction
Depression
/ etiology
Diskectomy
Female
Follow-Up Studies
Humans
Intervertebral Disc Displacement
/ complications
Male
Middle Aged
Pain
/ etiology
Patient Reported Outcome Measures
Retrospective Studies
ACL reconstruction
Discectomy
PROMIS
Patient reported outcome
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
22
01
2019
revised:
30
05
2019
accepted:
31
05
2019
pubmed:
24
6
2019
medline:
7
5
2020
entrez:
24
6
2019
Statut:
ppublish
Résumé
Society increasingly asks Medicine to create "value" for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative "value" of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate. The Patient Reported Outcome Measurement Information System (PROMIS) assessments for Physical Function, Pain Interference, and Depression are routinely collected in our orthopedic clinics. Patients who underwent lumbar discectomy (DSC) or arthroscopic anterior cruciate ligament reconstruction (ACLR) were retrospectively identified. Data relating to PROMIS domains, patient demographics, and other relevant encounter details were extracted. The primary outcomes were (1) preoperative PROMIS domain scores, (2) scores at a minimum of 40 days postoperatively for DSC patients and 133 days postoperatively for ACLR patients, and (3) the change in scores with surgery. Propensity score matching identified age-, sex-, race-, and comorbidity-matched groups from each cohort. Chi-square tests and nonparametric Kruskal-Wallis tests compared the distribution of outcomes and characteristics. Multivariate linear regression models with interactions between the matched cohort and operative phase estimated the change in the outcomes scores between the two cohorts and controlled for the baseline differences between them. Before surgery, the DSC cohort had lower physical function, higher pain interference and higher depression scores as compared with the ACLR cohort. This pattern remained postoperatively, indicating less desirable outcomes for DSC patients. However, after controlling for their baseline scores, DSC patients experienced significantly greater improvements after surgery of 3.84 (95% CI 1.08-6.60; p=.01), -4.87 (95% CI -7.52 to -2.23; p<.001), and -2.95 (95% CI -5.70 to -0.21; p=.04) points in their physical function, pain interference, and depression scores, respectively, as compared with ACLR patients. Based upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.
Sections du résumé
BACKGROUND CONTEXT
Society increasingly asks Medicine to create "value" for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative "value" of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate.
METHODS
The Patient Reported Outcome Measurement Information System (PROMIS) assessments for Physical Function, Pain Interference, and Depression are routinely collected in our orthopedic clinics. Patients who underwent lumbar discectomy (DSC) or arthroscopic anterior cruciate ligament reconstruction (ACLR) were retrospectively identified. Data relating to PROMIS domains, patient demographics, and other relevant encounter details were extracted. The primary outcomes were (1) preoperative PROMIS domain scores, (2) scores at a minimum of 40 days postoperatively for DSC patients and 133 days postoperatively for ACLR patients, and (3) the change in scores with surgery. Propensity score matching identified age-, sex-, race-, and comorbidity-matched groups from each cohort. Chi-square tests and nonparametric Kruskal-Wallis tests compared the distribution of outcomes and characteristics. Multivariate linear regression models with interactions between the matched cohort and operative phase estimated the change in the outcomes scores between the two cohorts and controlled for the baseline differences between them.
RESULTS
Before surgery, the DSC cohort had lower physical function, higher pain interference and higher depression scores as compared with the ACLR cohort. This pattern remained postoperatively, indicating less desirable outcomes for DSC patients. However, after controlling for their baseline scores, DSC patients experienced significantly greater improvements after surgery of 3.84 (95% CI 1.08-6.60; p=.01), -4.87 (95% CI -7.52 to -2.23; p<.001), and -2.95 (95% CI -5.70 to -0.21; p=.04) points in their physical function, pain interference, and depression scores, respectively, as compared with ACLR patients.
CONCLUSIONS
Based upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.
Identifiants
pubmed: 31229661
pii: S1529-9430(19)30792-2
doi: 10.1016/j.spinee.2019.05.595
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1850-1857Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.