P109. Tobacco use is associated with worse patient-reported outcomes following elective cervical spine surgery

OBJECTIVEOpioids are commonly prescribed after surgery for painful spinal conditions, yet little is known about postoperative opioid use. The relationship between chronic opioid use and patient-reported outcomes and satisfaction with surgery is also unclear. The purpose of this study was to evaluate factors associated with opioid use 1 year after elective cervical spine surgery for degenerative conditions causing radiculopathy and myelopathy. The authors hypothesized that patients with preoperative opioid use would be more likely to report postoperative opioid use at 1 year, and that postoperative opioid use would be associated with patient-reported outcomes and dissatisfaction with surgery.METHODSThe authors performed a retrospective study of a prospective cohort of adult patients who underwent elective cervical spine surgery for degenerative changes causing radiculopathy or myelopathy. Patients were prospectively and consecutively enrolled from a single academic center after the decision for surgery had been made. Postoperative in-hospital pain management was conducted using a standardized protocol. The primary outcome was any opioid use 1 year after surgery. Secondary outcomes were the Neck Disability Index (NDI); 36-Item Short-Form Health Survey (SF-36) physical function (PF), bodily pain (BP), and mental component summary (MCS) scores; the modified Japanese Orthopaedic Association (mJOA) score among myelopathy patients; and patient expectations surveys. Patients with and without preoperative opioid use were compared using the chi-square and Student t-tests, and multiple logistic regression was used to study the associations between patient and surgical characteristics and postoperative opioid use 1 year after surgery.RESULTSTwo hundred eleven patients were prospectively and consecutively enrolled, of whom 39 were lost to follow-up for the primary outcome; 43.6% reported preoperative opioid use. Preoperative NDI and SF-36 PF and BP scores were significantly worse in the preoperative opioid cohort. More than 94% of both cohorts rated expectations of pain relief as extremely or somewhat important. At 1 year after surgery, 50.7% of the preoperative-opioid-use cohort reported ongoing opioid use, and 17.5% of patients in the no-preoperative-opioid-use cohort reported ongoing opioid use. Despite this, both cohorts reported similar improvements in NDI as well as SF-36 PF, BP, and MCS scores. More than 70% of both cohorts also reported being extremely or somewhat satisfied with pain relief after surgery. Predictors of 1-year opioid use included preoperative opioid use, duration of symptoms for more than 9 months before surgery, tobacco use, and higher comorbidity index.CONCLUSIONSOne year after elective cervical spine surgery, patients with preoperative opioid use were significantly more likely to report ongoing opioid use. However, patients in both groups reported similar improvements in patient-reported outcomes and satisfaction with pain relief. Interventions targeted at decreasing opioid use may need to focus on patient factors such as preoperative opioid use or duration of symptoms before surgery.

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Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

The Spine Journal ◽

10.1016/j.spinee.2017.02.008 ◽

2017 ◽

Vol 17 (7) ◽

pp. 943-952 ◽

Cited By ~ 10

Author(s):

Gregory D. Schroeder ◽

Dom Coric ◽

Han Jo Kim ◽

Todd J. Albert ◽

Kris E. Radcliff

Keyword(s):

Patient Satisfaction ◽

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Patient Reported

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Current Trends in the Use of Patient-Reported Outcome Instruments in Degenerative Cervical Spine Surgery

Global Spine Journal ◽

10.1055/s-0035-1559584 ◽

2015 ◽

Vol 6 (3) ◽

pp. 242-247 ◽

Cited By ~ 5

Author(s):

Haruki Ueda ◽

Holt S. Cutler ◽

Javier Z. Guzman ◽

Samuel K. Cho

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcome ◽

Cervical Spine Surgery ◽

Current Trends ◽

Patient Reported ◽

Degenerative Cervical Spine

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Utilization of Patient Reported Outcome Instruments in Degenerative Cervical Spine Surgery

The Spine Journal ◽

10.1016/j.spinee.2014.08.353 ◽

2014 ◽

Vol 14 (11) ◽

pp. S145-S146

Author(s):

Javier Guzman ◽

Holt Cutler ◽

Motasem Al Maaieh ◽

James Connolly ◽

Branko Skovrlj ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcome ◽

Cervical Spine Surgery ◽

Patient Reported ◽

Degenerative Cervical Spine

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PROMIS-29 Validity and Conversion Equation to Neck Disability Index (NDI) using a National Sample of Cervical Spine Surgery Patients

Neurosurgery ◽

10.1093/neuros/nyz310_331 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Inamullah Khan ◽

Jacquelyn S Pennings ◽

Claudia Davidson ◽

Mohamad Bydon ◽

Anthony L Asher ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Neck Disability Index ◽

Reliability And Validity ◽

National Registry ◽

Good Reliability ◽

Cervical Spine Surgery ◽

Cervical Surgery ◽

Patient Reported ◽

Conversion Equation

Abstract INTRODUCTION Patient Reported Outcomes Measures (PROMs) have become a vital tool for evaluating success of spine surgery. The purpose was to examine the validity of the PROMIS-29 to better understand it's use for cervical spine surgery patients. A secondary objective was to calculate a conversion equation between PROMIS-29 and NDI, to allow researchers and clinicians to determine a predicted NDI. METHODS We conducted a retrospective analysis of prospectively collected national registry data, the Quality Outcomes Database (QOD), which is designed to evaluate risk-adjusted outcomes for the most commonly performed spinal surgical procedures. We queried the QOD registry for patients with PROMIS-29 and NDI responses. Of 619 patients, 41% were female, 87% Caucasian, and 13% had revision surgery. The mean age was 58 yr (SD = 12). Validity of the PROMIS-29 was assessed using Cronbach's a, ceiling/floor effects, and principle axis factoring. Multivariable regression predicting NDI scores from PROMIS-29 domains used data from all three timepoints. Predicted NDI scores, derived from PROMIS-29 domains, were plotted against NDI scores to determine how well PROMIS-29 domains predicted NDI. A conversion equation was created from PROMIS regression coefficients. RESULTS Results showed good reliability (Cronbach's a >0.80) and validity of PROMIS-29 in patients undergoing cervical surgery: convergent (r > 0.65) and discriminant (r = 0.49-0.63) validity, low/high floor/ceiling effects (=2%), and unidimensional domains (factor loading >0.64). The conversion equation used 6 PROMIS-29 domains (NDIpercent = 7.928-0.527*[PFraw] + 1.570*[PAINraw] +0.995*[SDraw] + 1.101[PIraw] + 0.392[Fatigueraw] 0.409 [SRraw]). Correlations between predicted and actual NDI scores at each timepoint were: r = 0.84 at baseline, r = 0.76 at 3 mo, and r = 0.84 at 12 mo, suggesting that the equation predicted NDI-scores that are strongly correlated with actual NDI-scores. CONCLUSION Good reliability and validity support the use of PROMIS-29 in cervical surgery patients. Findings suggest accurate NDI score can be derived from PROMIS-29 domains. These results support the idea that PROMIS-29 domains have the potential to replace disease-specific traditional PROMs like NDI.

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A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database

Neurosurgical FOCUS ◽

10.3171/2018.8.focus18326 ◽

2018 ◽

Vol 45 (5) ◽

pp. E9 ◽

Cited By ~ 9

Author(s):

Clinton J. Devin ◽

Mohamad Bydon ◽

Mohammed Ali Alvi ◽

Panagiotis Kerezoudis ◽

Inamullah Khan ◽

...

Keyword(s):

Logistic Regression ◽

Cervical Spine ◽

Return To Work ◽

Spine Surgery ◽

Multivariable Analysis ◽

Quality Outcomes ◽

Cervical Spine Surgery ◽

Factors Associated ◽

Multivariable Logistic Regression ◽

Patient Reported

OBJECTIVEBack pain and neck pain are two of the most common causes of work loss due to disability, which poses an economic burden on society. Due to recent changes in healthcare policies, patient-centered outcomes including return to work have been increasingly prioritized by physicians and hospitals to optimize healthcare delivery. In this study, the authors used a national spine registry to identify clinical factors associated with return to work at 3 months among patients undergoing a cervical spine surgery.METHODSThe authors queried the Quality Outcomes Database registry for information collected from April 2013 through March 2017 for preoperatively employed patients undergoing cervical spine surgery for degenerative spine disease. Covariates included demographic, clinical, and operative variables, and baseline patient-reported outcomes. Multiple imputations were used for missing values and multivariable logistic regression analysis was used to identify factors associated with higher odds of returning to work. Bootstrap resampling (200 iterations) was used to assess the validity of the model. A nomogram was constructed using the results of the multivariable model.RESULTSA total of 4689 patients were analyzed, of whom 82.2% (n = 3854) returned to work at 3 months postoperatively. Among previously employed and working patients, 89.3% (n = 3443) returned to work compared to 52.3% (n = 411) among those who were employed but not working (e.g., were on a leave) at the time of surgery (p < 0.001). On multivariable logistic regression the authors found that patients who were less likely to return to work were older (age > 56–65 years: OR 0.69, 95% CI 0.57–0.85, p < 0.001; age > 65 years: OR 0.65, 95% CI 0.43–0.97, p = 0.02); were employed but not working (OR 0.24, 95% CI 0.20–0.29, p < 0.001); were employed part time (OR 0.56, 95% CI 0.42–0.76, p < 0.001); had a heavy-intensity (OR 0.42, 95% CI 0.32–0.54, p < 0.001) or medium-intensity (OR 0.59, 95% CI 0.46–0.76, p < 0.001) occupation compared to a sedentary occupation type; had workers’ compensation (OR 0.38, 95% CI 0.28–0.53, p < 0.001); had a higher Neck Disability Index score at baseline (OR 0.60, 95% CI 0.51–0.70, p = 0.017); were more likely to present with myelopathy (OR 0.52, 95% CI 0.42–0.63, p < 0.001); and had more levels fused (3–5 levels: OR 0.46, 95% CI 0.35–0.61, p < 0.001). Using the multivariable analysis, the authors then constructed a nomogram to predict return to work, which was found to have an area under the curve of 0.812 and good validity.CONCLUSIONSReturn to work is a crucial outcome that is being increasingly prioritized for employed patients undergoing spine surgery. The results from this study could help surgeons identify at-risk patients so that preoperative expectations could be discussed more comprehensively.

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