Spine Research Fellow Hospital for Special Surgery Hospital for Special Surgery
Disclosure(s):
Cole Kwas, BA: No financial relationships to disclose
Introduction: The PROMIS questionnaire has been recently developed as a computer-adaptive metric to evaluate global health and disability with improved psychometric properties and reduced questionnaire burden to the patient compared to legacy PROMs. As CDRs continue to be performed at an increasing rate, understanding how patients’ preoperative disability and global health, as conveyed through the PROMIS PF domain, are associated with postoperative outcomes will be useful in the preoperative counseling of patients. Therefore, this study aimed to evaluate the influence of preoperative PROMIS PF on outcomes following CDR, focusing on postoperative pain, narcotics consumption, return to activities, and PROMs.
Methods: Patients undergoing primary 1- or 2-level CDR for degenerative pathology with minimum 6-month follow-up were included and separated into a high disability group (≤40 preoperative PROMIS PF) and a low disability group (>40 preoperative PROMIS PF). Analyses were conducted for the early ( < 6 months) and late (≥6 months) postoperative timepoints. Linear and logistic regressions were performed to determine the association of preoperative PROMIS PF group with postoperative pain, narcotics consumption, time to discontinue narcotics, return to driving and working, PROMs, and MCID achievement.
Results: 93 patients were included. Patients in the high disability group were younger (41.5±8.4 vs. 45.3±7.6, p=0.026) and had a higher proportion of female patients (58.7% vs. 25.6%, p=0.001). Patients with higher disability experienced similar postoperative pain scores, narcotics consumption, time to discontinue narcotics, and return to driving and working timelines as patients with lower disability but demonstrated poorer PROM scores at early follow-up. However, patients with higher disability experienced greater changes in NDI and PROMIS PF scores at both early and late follow-up, VAS-Neck and Arm and SF-12 PCS scores at late follow-up, and achieved the MCID at a higher rate for multiple PROMs.
Conclusion : Patients with higher preoperative disability, as determined by PROMIS PF, experience similar postoperative pain scores, narcotics consumption, time to discontinue narcotics, and return to activities as compared to patients with lower preoperative disability undergoing CDR as well as greater absolute improvements and MCID achievement rates for most PROMs. These findings may be useful in setting postoperative expectations for outcomes following CDR.