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

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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Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Workerʼs Compensation Setting

Spine ◽

10.1097/brs.0000000000002978 ◽

2019 ◽

Vol 44 (13) ◽

pp. 903-907

Author(s):

Elliott J. Kim ◽

Silky Chotai ◽

Joseph B. Wick ◽

Inamullah Khan ◽

Ahilan Sivaganesan ◽

...

Keyword(s):

Cervical Spine ◽

Return To Work ◽

Spine Surgery ◽

Cervical Spine Surgery ◽

Factors Associated

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Letter to the Editor concerning “Development and Validation of Cervical Prediction Models for Patient-Reported Outcomes at 1 Year After Cervical Spine Surgery for Radiculopathy and Myelopathy“ by Archer et al. Spine 45

Spine ◽

10.1097/brs.0000000000003950 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Anthony H. Woodward

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Prediction Models ◽

Cervical Spine Surgery ◽

Letter To The Editor ◽

Patient Reported ◽

Development And Validation

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233. Does postoperative physical therapy improve patient-reported outcomes at one-year following cervical spine surgery?

The Spine Journal ◽

10.1016/j.spinee.2019.05.248 ◽

2019 ◽

Vol 19 (9) ◽

pp. S114-S115

Author(s):

Kristin R. Archer ◽

Jacquelyn S. Pennings ◽

Inamullah Khan ◽

Ahilan Sivaganesan ◽

JP Wanner ◽

...

Keyword(s):

Cervical Spine ◽

Physical Therapy ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Cervical Spine Surgery ◽

Patient Reported ◽

Postoperative Physical Therapy ◽

One Year ◽

Improve Patient

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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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Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201442 ◽

2021 ◽

pp. 1-9

Author(s):

Praveen V. Mummaneni ◽

Mohamad Bydon ◽

John J. Knightly ◽

Mohammed Ali Alvi ◽

Yagiz U. Yolcu ◽

...

Keyword(s):

Quality Of Life ◽

Logistic Regression ◽

African American ◽

Cervical Myelopathy ◽

Demographic Characteristics ◽

Quality Outcomes ◽

Factors Associated ◽

Multivariable Logistic Regression ◽

Predictor Importance

OBJECTIVE Optimizing patient discharge after surgery has been shown to impact patient recovery and hospital/physician workflow and to reduce healthcare costs. In the current study, the authors sought to identify risk factors for nonroutine discharge after surgery for cervical myelopathy by using a national spine registry. METHODS The Quality Outcomes Database cervical module was queried for patients who had undergone surgery for cervical myelopathy between 2016 and 2018. Nonroutine discharge was defined as discharge to postacute care (rehabilitation), nonacute care, or another acute care hospital. A multivariable logistic regression predictive model was created using an array of demographic, clinical, operative, and patient-reported outcome characteristics. RESULTS Of the 1114 patients identified, 11.2% (n = 125) had a nonroutine discharge. On univariate analysis, patients with a nonroutine discharge were more likely to be older (age ≥ 65 years, 70.4% vs 35.8%, p < 0.001), African American (24.8% vs 13.9%, p = 0.007), and on Medicare (75.2% vs 35.1%, p < 0.001). Among the patients younger than 65 years of age, those who had a nonroutine discharge were more likely to be unemployed (70.3% vs 36.9%, p < 0.001). Overall, patients with a nonroutine discharge were more likely to present with a motor deficit (73.6% vs 58.7%, p = 0.001) and more likely to have nonindependent ambulation (50.4% vs 14.0%, p < 0.001) at presentation. On multivariable logistic regression, factors associated with higher odds of a nonroutine discharge included African American race (vs White, OR 2.76, 95% CI 1.38–5.51, p = 0.004), Medicare coverage (vs private insurance, OR 2.14, 95% CI 1.00–4.65, p = 0.04), nonindependent ambulation at presentation (OR 2.17, 95% CI 1.17–4.02, p = 0.01), baseline modified Japanese Orthopaedic Association severe myelopathy score (0–11 vs moderate 12–14, OR 2, 95% CI 1.07–3.73, p = 0.01), and posterior surgical approach (OR 11.6, 95% CI 2.12–48, p = 0.004). Factors associated with lower odds of a nonroutine discharge included fewer operated levels (1 vs 2–3 levels, OR 0.3, 95% CI 0.1–0.96, p = 0.009) and a higher quality of life at baseline (EQ-5D score, OR 0.43, 95% CI 0.25–0.73, p = 0.001). On predictor importance analysis, baseline quality of life (EQ-5D score) was identified as the most important predictor (Wald χ2 = 9.8, p = 0.001) of a nonroutine discharge; however, after grouping variables into distinct categories, socioeconomic and demographic characteristics (age, race, gender, insurance status, employment status) were identified as the most significant drivers of nonroutine discharge (28.4% of total predictor importance). CONCLUSIONS The study results indicate that socioeconomic and demographic characteristics including age, race, gender, insurance, and employment may be the most significant drivers of a nonroutine discharge after surgery for cervical myelopathy.

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Erratum. Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database

Journal of Neurosurgery Spine ◽

10.3171/2021.11.spine202002a ◽

2021 ◽

pp. 1-2

Author(s):

Mohamad Bydon

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Quality Outcomes ◽

Cervical Spine Surgery ◽

Predominant Symptom

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Risk factor analysis and severity assessment of wound hematoma after anterior cervical spine surgery: A retrospective study

10.21203/rs.3.rs-120516/v1 ◽

2020 ◽

Author(s):

Kai Zhou ◽

Zhengxue Quan ◽

Zhongyuan He ◽

Ke Tang

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cervical Spine ◽

Spine Surgery ◽

Cervical Disc ◽

Multivariate Logistic Regression ◽

Cervical Spine Surgery ◽

Hematoma Formation ◽

Anterior Cervical Spine Surgery ◽

History Of

Abstract Background We aim to explore the risk factors independently associated with postoperative wound hematoma in patients who have undergone anterior cervical spine surgery. Methods The clinical data of patients with cervical spondylosis or cervical disc herniation who underwent anterior cervical spine surgery by the senior author from January 2011 to December 2017 were evaluated. Multivariate logistic regression was conducted to compare the hematoma group and the no-hematoma group to determine which factors were independently associated with hematoma formation in patients who need evacuation. The Mann-Whitney U test was conducted to compare the Neck Disability Index score in the two groups. Results A total of 678 patients met the criteria and underwent anterior cervical spine surgery. Thirteen patients undergone hematoma evacuation. Multivariate logistic regression analysis identified that history of hypertension (p = 0.039 OR = 4.42 95% CI 1.08–18.07) and therapeutic heparin use (p = 0.020 OR = 4.58 95% CI 1.27–16.59) were independent risk factors for hematoma formation. The t-test showed no significant differences between the hematoma group and the no-hematoma group in terms of APTT or PT levels (p > 0.05). The Mann-Whitney U test indicated that there was no difference in NDI scores between the two groups(p > 0.05). Conclusion History of hypertension and therapeutic heparin use are risk factors for hematoma formation. Meticulous hemostasis, moderate muscle subtraction, and perioperative airway management are critical for avoiding hematoma development. The Neck Hematoma Scores can quickly determine the severity of a hematoma in the absence of radiographic image evidence.

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Which factors predict discordance between a patient and physician on a gout flare?

Rheumatology ◽

10.1093/rheumatology/keaa413 ◽

2020 ◽

Author(s):

Aprajita Jagpal ◽

Elizabeth J Rahn ◽

Amy S Mudano ◽

Nicola Dalbeth ◽

William Taylor ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariable Logistic Regression Analysis ◽

Factors Associated ◽

Pain Scores ◽

Multivariable Logistic Regression ◽

Patient Reported ◽

Gout Flare ◽

Gout Flares

Abstract Objective To investigate the factors associated with discordance between patient and physician on the presence of a gout flare. Methods Patients’ self-reports of current gout flares were assessed with the question, ‘Are you having a gout flare today?’ which was then compared with a concurrent, blinded, physician’s assessment. Based on agreement or disagreement with physicians on the presence of a gout flare, flares were divided into concordant and discordant groups, respectively. Within the discordant group, two subgroups—patient-reported flare but the physician disagreed and physician-reported flare but the patient disagreed—were identified. The factors associated with discordance were analysed with multivariable logistic regression analysis. Results Of 268 gout flares, 81 (30.2%) flares were discordant, with either patient or physician disagreeing on the presence of a flare. Of the discordant flares, in 57 (70.4%) the patient reported a flare but the physician disagreed. In multivariable logistic regression analysis adjusted for demographics, disagreement among patients and physicians on the presence of a gout flare was associated with lower pain scores at rest [odds ratio (OR) for each point increase on 0–10 point pain scale 0.81 (95% Wald CI 0.73, 0.90), P < 0.0001] and less presence of joint swelling [OR 0.24 (95% CI 0.10, 0.61), P = 0.003] or joint warmth [OR 0.39 (95% CI 0.20, 0.75), P = 0.005]. Conclusion Although patients and physicians generally agree about the presence of gout flare, discordance may occur in the setting of low pain scores and in the absence of swollen or warm joints.

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