The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity

Micheal Raad, Brian J. Neuman, Amit Jain, Hamid Hassanzadeh, Peter G. Passias, Eric Otto Klineberg, Gregory M. Mundis, Themistocles S. Protopsaltis, Emily K. Miller, Justin S. Smith, Virginie Lafage, D. Kojo Hamilton, Shay Bess, Khaled M. Kebaish, Daniel M. Sciubba

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity. METHODS This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively. RESULTS A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001). CONCLUSIONS The authors’ results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients’ preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.

Original languageEnglish (US)
Pages (from-to)68-74
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume29
Issue number1
DOIs
StatePublished - Jul 1 2018

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Length of Stay
Scoliosis
Quality of Life
Logistic Models
Research
Quality of Health Care
Health Resources
Comorbidity
Multivariate Analysis
Odds Ratio
Regression Analysis
Databases
Delivery of Health Care
Costs and Cost Analysis
Pain
Incidence
Surveys and Questionnaires

Keywords

  • Adult spinal deformity
  • Patient stratification
  • Physical component summary
  • Preoperative activity
  • Scoliosis research society-22r patient questionnaire

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity. / Raad, Micheal; Neuman, Brian J.; Jain, Amit; Hassanzadeh, Hamid; Passias, Peter G.; Klineberg, Eric Otto; Mundis, Gregory M.; Protopsaltis, Themistocles S.; Miller, Emily K.; Smith, Justin S.; Lafage, Virginie; Hamilton, D. Kojo; Bess, Shay; Kebaish, Khaled M.; Sciubba, Daniel M.

In: Journal of Neurosurgery: Spine, Vol. 29, No. 1, 01.07.2018, p. 68-74.

Research output: Contribution to journalArticle

Raad, M, Neuman, BJ, Jain, A, Hassanzadeh, H, Passias, PG, Klineberg, EO, Mundis, GM, Protopsaltis, TS, Miller, EK, Smith, JS, Lafage, V, Hamilton, DK, Bess, S, Kebaish, KM & Sciubba, DM 2018, 'The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity', Journal of Neurosurgery: Spine, vol. 29, no. 1, pp. 68-74. https://doi.org/10.3171/2017.10.SPINE17830
Raad, Micheal ; Neuman, Brian J. ; Jain, Amit ; Hassanzadeh, Hamid ; Passias, Peter G. ; Klineberg, Eric Otto ; Mundis, Gregory M. ; Protopsaltis, Themistocles S. ; Miller, Emily K. ; Smith, Justin S. ; Lafage, Virginie ; Hamilton, D. Kojo ; Bess, Shay ; Kebaish, Khaled M. ; Sciubba, Daniel M. / The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity. In: Journal of Neurosurgery: Spine. 2018 ; Vol. 29, No. 1. pp. 68-74.
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T1 - The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity

AU - Raad, Micheal

AU - Neuman, Brian J.

AU - Jain, Amit

AU - Hassanzadeh, Hamid

AU - Passias, Peter G.

AU - Klineberg, Eric Otto

AU - Mundis, Gregory M.

AU - Protopsaltis, Themistocles S.

AU - Miller, Emily K.

AU - Smith, Justin S.

AU - Lafage, Virginie

AU - Hamilton, D. Kojo

AU - Bess, Shay

AU - Kebaish, Khaled M.

AU - Sciubba, Daniel M.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - OBJECTIVE Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity. METHODS This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively. RESULTS A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001). CONCLUSIONS The authors’ results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients’ preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.

AB - OBJECTIVE Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity. METHODS This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively. RESULTS A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001). CONCLUSIONS The authors’ results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients’ preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.

KW - Adult spinal deformity

KW - Patient stratification

KW - Physical component summary

KW - Preoperative activity

KW - Scoliosis research society-22r patient questionnaire

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