68. Early patient-reported outcomes can be used to identify patients at risk for poor 1-year outcomes in adult spinal deformity

Abstract

BACKGROUND CONTEXT The progression of patient-reported outcomes (PRO) scores postoperatively in adult spinal deformity (ASD) is not well understood. Estimating when outcomes plateau and when minimum clinically important differences (MCIDs) are achieved could result in early identification of patients at risk for poor outcomes, and allow for early intervention. It may also help set patient expectations on when they will experience the benefits of surgery. This study examines the relationship between early and 1-year postoperative PROMIS outcomes scores. It further evaluates whether early assessments can predict failure to achieve PROMIS minimal clinically important differences (MCIDs) at 1 year. PURPOSE To determine whether failure to achieve MCIDs at 3 months leads to lower likelihood to achieve them after 1 year. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Seventy-eight ASD patients. OUTCOME MEASURES PROMIS domains, achievement of MCIDs. METHODS Surgical ASD patients from 2015-2018 with 3-month and 1-year postoperative follow-up were evaluated. PROMIS scores were obtained preoperatively, at all follow-up appointments. PROMIS domains assessed were pain interference, physical function, anxiety, depression, fatigue, sleep disturbance and satisfaction with participation in social roles. First, we correlated assessments at 3 months to those at 1 year. Then, to determine whether failure to achieve MCIDs at 3 months postoperatively resulted in a lower likelihood to achieve them after 1 year, we performed a logistic regression for each PROMIS domain, adjusting for age, gender, race and preoperative scores. MCIDs used for this purpose, specifically computed for the ASD population, were: pain interference, -6.4; physical function, 4.8; anxiety, -6.5; depression, -5.7; fatigue, -6.4; sleep disturbance, -5.6; satisfaction with participation in social roles, 6.0. RESULTS Seventy-eight ASD patients (mean age 59.2 years) undergoing surgery for ASD were included. There were moderate correlations between 3-month and 1-year assessments in all domains (0.45 CONCLUSIONS Patients who fail to achieve PROMIS MCIDs by 3 months postoperatively are unlikely to achieve them after 1 year in domains of pain interference, physical function, anxiety and depression. Thus, early assessments allow identification of patients at risk for poor outcomes and present an opportunity for early intervention. They can also be used to set patient expectations after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.