93. Differences in patient reported outcomes between patients who do and do not complete PROMIS surveys

Abstract

<h3>BACKGROUND CONTEXT</h3> Patient-Reported Outcomes Measurement Information System (PROMIS) has been well validated as a tool for assessing patient reported outcomes in spine surgery. However, as with any self-reported survey, PROMIS is vulnerable to response bias. There is currently a dearth of literature assessing differences in patients who do and do not complete PROMIS surveys. <h3>PURPOSE</h3> To characterize differences in patient reported outcome measure (PROM) scores between patients who do and do not complete PROMIS physical function (PF) surveys following lumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 983 patients undergoing primary lumbar spine procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire (PHQ-9), visual analog score (VAS) back and leg, Oswestry Disability Index (ODI) and 12-Item Short Form Physical Composite Summary (SF-12 PCS) <h3>METHODS</h3> A prospectively maintained surgical database was retrospectively reviewed for primary lumbar spine procedures from May 2015 to July 2020. Procedures indicated for traumatic, infectious, or malignant etiologies were excluded. Patient demographic and operative data were collected. Outcome measures for PHQ-9, VAS back and leg, ODI and SF-12 PCS were recorded at both pre- and postoperative (6-week, 12-week, 6-month, 1-year, 2-year) timepoints. Completion rates for PROMIS PF surveys were recorded for each of the above timepoints. PROMIS PF survey dates that were before or after the window when patients could have potentially completed the survey (eg, ≤1 year after study start or before study end for 1-year PROMIS surveys) were excluded from this analysis. Descriptive statistics were performed for demographic and operative variables. Patients were categorized into groups at each timepoint based on whether or not PROMIS PF was completed. A t-test for independent samples was used to determine differences in mean scores for each PROM at each timepoint between groups. <h3>RESULTS</h3> A total of 983 patients were included in this study with an average age of 48.8 years. A majority were male (66.5%), had a body mass index <30 kg/m2 (60.0%), and were nonsmokers (88.3%). The most common spinal pathology was recurrent herniated nucleus pulposus at 53.2%. Means values for operative variables were 86.6 minutes for operative time, 42.8mL for estimated blood loss, and 18.0 hours for length of stay. No significant differences were observed for all outcome measures between PROMIS completion groups at the preoperative timepoint. PHQ-9 and VAS back scores differed significantly between groups through 1-year (all p<0.05). Significant differences in VAS leg and ODI scores were demonstrated through 6-months (all p<0.05), but not at 1-year. SF-12 PCS differed significantly between PROMIS completion groups only at 6-weeks (p=0.018). <h3>CONCLUSIONS</h3> Patients who did not complete PROMIS PF surveys had significantly poorer outcomes than those that did in terms of postoperative depressive symptoms, pain, and disability. These results suggest that patents completing PROMIS questionnaires may represent a healthier cohort than the overall lumbar spine population. Interestingly, these differences were not observed for preoperative scores and to a lesser extent for physical function. This finding may be reassuring, since PROMIS PF's primary function is to assess patient physical function. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.