P127. PROMIS better reflects the impact of length of stay and the occurrence of complications within 90 days than legacy outcome measures for lumbar degenerative surgery

Abstract

BACKGROUND CONTEXT The Patient Reported Outcome Measurement Information System (PROMIS) aims to offer a valid, reliable and efficient means of capturing spine surgery patient clinical outcomes. To date, few studies have compared PROMIS and legacy outcome measures like the Oswestry Disability Index (ODI) for their sensitivity in reflecting the impact of perioperative complications and length of stay. PURPOSE Assess differences between PROMIS and ODI scores as they relate to length of stay and complication outcomes of surgical thoracolumbar patients. STUDY DESIGN/SETTING Retrospective review of single institution clinical data and patient-reported outcome measures. PATIENT SAMPLE A total of 182 patients undergoing thoracolumbar surgery. OUTCOME MEASURES Length of stay (LOS), perioperative complications. METHODS Patients >18 years undergoing thoracolumbar surgery with available pre- and 3-month postoperative ODI and PROMIS scores were included. Pearson bivariate correlation assessed the linear relationships between clinical outcomes (including length of stay, complications) and scores for both PROMIS (Physical Function, Pain Intensity, Pain Interference) and ODI. Linear regression predicted the relationship between perioperative complication incidence and postop scores for ODI and PROMIS. Significance was set p RESULTS Included: 182 patients (55.2±16.1 years, 44.5% female, 29.5±6.3 kg/m2) undergoing thoracolumbar surgery. Among the most common diagnoses were stenosis (62.1%), radiculopathy (48.9%), herniated disc (47.8%), and degenerative spondylolisthesis (25.3%). Overall, 58.3% of patients underwent fusion (mean fusion length: 2.6±2.9 levels), 50% underwent laminectomy, 82.9% of cases involved posterior-only approach, 17.6% combined, and 0.5% anterior-only. Patients showed significant pre- to postoperative improvement in both ODI (50.2 to 39.0) and PROMIS Physical Function (10.9 to 21.4), Pain Intensity (92.4 to 78.3) and Pain Interference (58.4 to 49.8, all p 0.05); however, 3-month postoperative scores for Physical Function (r=-0.205, p=0.005) and Pain Interference (r=0.182, p=0.014) both showed stronger correlations with complication occurrence than ODI (r=0.143, p=0.055). Regression analysis showed that while perioperative complication incidence could not predict postoperative ODI (p>0.05), complication occurrence predicted Physical Function (R2=0.037, p=0.005) and Pain Interference (R2=0.028, p=0.014) scores. CONCLUSIONS The PROMIS domains of Physical Function and Pain Interference better reflected perioperative complications and length of stay as compared to the legacy patient reported outcome ODI. These results suggest PROMIS may offer more utility as an outcomes assessment instrument. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.