Postoperative Patient-Reported Outcomes Measurement Information System Research Articles

Modified Lapidus vs Scarf Osteotomy Outcomes for Treatment of Hallux Valgus Deformity.

The Lapidus procedure and scarf osteotomy are indicated for the operative treatment of hallux valgus; however, no prior studies have compared outcomes between the procedures. The aim of this study was to compare clinical and radiographic outcomes between patients with symptomatic hallux valgus treated with the modified Lapidus procedure versus scarf osteotomy. This retrospective cohort study included patients treated by 1 of 7 fellowship-trained foot and ankle surgeons. Inclusion criteria were age older than 18 years, primary modified Lapidus procedure or scarf osteotomy for hallux valgus, minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and minimum 3-month postoperative radiographs. Revision cases were excluded. Clinical outcomes were assessed using 6 PROMIS domains. Pre- and postoperative radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders. A total of 136 patients (73 Lapidus, 63 scarf) with an average of 17.8 months of follow-up were included in this study. There was significant improvement in PROMIS physical function scores in the modified Lapidus (mean change, 5.25; P < .01) and scarf osteotomy (mean change, 5.50; P < .01) cohorts, with no significant differences between the 2 groups (P = .85). After controlling for bunion severity, the probability of having a normal postoperative intermetatarsal angle (IMA; <9 degrees) was 25% lower (P = .04) with the scarf osteotomy compared with the Lapidus procedure. Although the modified Lapidus procedure led to a higher probability of achieving a normal IMA, both procedures yielded similar improvements in 1-year patient-reported outcome measures. Level III, retrospective cohort.

Preoperative Patient-Reported Outcomes Measurement Information System Global Health Scores Predict Patients Achieving the Minimal Clinically Important Difference in the Early Postoperative Time Period After Total Knee Arthroplasty.

The patient-specific factors influencing postoperative improvement after total knee arthroplasty (TKA) are important considerations for the surgeon and patient. The primary purpose of this study was to determine which patient demographic factors influence the postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health (GH) scores. In addition, we aimed to compare the prognostic utility of preoperative PROMIS-GH scores and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) in predicting postoperative improvement. This retrospective cohort study of a consecutive series of patients who underwent primary, unilateral TKA analyzed prospectively collected KOOS-JR and PROMIS-GH surveys. PROMIS-GH includes physical health (PH) and mental health scores. Patient demographic and presurgical characteristics were evaluated for prognostic capability in predicting postoperative improvement in the PROMIS scores and achievement of the minimal clinically important difference (MCID). Receiver operating characteristic curves were used to understand the prognostic thresholds of the preoperative PROMIS score and KOOS-JR for predicting MCID achievement. A total of 872 patients were included. Although unadjusted analyses showed associations between patient demographic factors and PROMIS-PH scores, multivariable regression analysis for predictors of MCID achievement demonstrated that PROMIS-PH was the only significant preoperative variable. Receiver operating characteristic analysis revealed that the area under the curve of PROMIS-PH (0.70; 95% CI, 0.67 to 0.74) was less than that of the KOOS-JR (0.77; 95% CI, 0.73 to 0.81; P = 0.032). Sensitivity and specificity for achieving the MCID were maximized for preoperative PROMIS-PH scores of ≤ 38 (59% and 70%) and for preoperative KOOS-JR ≤ 51 (71% and 69%). Preoperative KOOS-JR and PROMIS-PH scores predict clinically meaningful improvement after TKA. The KOOS-JR has greater prognostic utility in the early postoperative period. Level III, Prognostic Study.

Impact of Preoperative Opioid Use on Postoperative Patient-reported Outcomes in Lumbar Spine Surgery Patients.

This was a retrospective cohort study. Investigate the impact of preoperative opioid use on postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores in patients undergoing elective spine surgery. The PROMIS has demonstrated reliability and validity in conditions such as lumbar stenosis, disc herniation, and cervical spondylosis. Although previous studies have identified the negative impact of preoperative opioid use on legacy patient-reported outcome measures following lumbar spine surgery, no study to date has utilized PROMIS computer adaptive tests. Consecutive patients who underwent lumbar spine surgery at a single institution between 2014 and 2016 completed PROMIS PF and PI scores at baseline preoperatively and at 3, 12, and 24 months postoperatively. Preoperative opioid use was defined as >1 month before surgery. Univariate and linear mixed model multivariate analysis was performed to evaluate for correlation of preoperative opioid use, as well as patient risk factors, with postoperative PROMIS PI and PF scores at each time point. Ninety-one patients met inclusion criteria with PROMIS scores at every time point. A total of 36 (39.6%) patients self-reported taking opioids at the time of surgery. Mean duration of opioid use among opioid users was 6.5±7.4 months. Patients taking preoperative opioids had significantly less improvement at all time points out to 24 months. At 24 months, patients in the nonopioid group had mean PI improvement of -13.0±14.2 versus -4.9±15.4 in the opioid group (P=0.014). The mean postoperative improvement in the opioid group did not achieve minimally clinically important difference (MCID) of 8 at any time point. Patients who do not use opioids preoperatively show significant postsurgical improvement in PI scores compared with patients who use preoperative opioids. Mean improvement in PROMIS PI scores failed to meet an MCID of 8 in opioid users, whereas mean improvement exceeded this MCID in opioid naive patients. The results of this study help elucidate the deleterious impact of opioids, allowing surgeons to better set patient expectations. Level III.

P132. PROMIS depression and anxiety correlate with postoperative NASS satisfaction in cervical patients

BACKGROUND CONTEXT Poor mental health is associated with lower satisfaction in surgery at large. Many cervical spine patients endorse psychiatric symptoms, but there is limited understanding of how these symptoms are related to postoperative satisfaction. The NASS satisfaction scale serves as a metric for satisfaction, with lower numbers indicating higher satisfaction. Mental health can be assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety (0 to 100 point scales with higher scores for severe symptoms) both preoperatively and postoperatively. PURPOSE To determine whether preoperative and postoperative PROMIS Depression and Anxiety scores correlate with postoperative satisfaction. STUDY DESIGN/SETTING Retrospective review at a single institution. PATIENT SAMPLE A total of 60 cervical patients. OUTCOME MEASURES NASS satisfaction score. METHODS PROMIS Depression, PROMIS Anxiety, and NASS satisfaction scores were collected for surgical cervical patients preoperatively and at 3 months postoperatively. Correlation was assessed for each preoperative and postoperative mental health metric versus postoperative satisfaction. RESULTS A total of 60 cervical patients (avg. age 63 years old) had mean satisfaction of 1.5 [1.2 to 1.7]. Each postoperative mental health metric moderately correlated with satisfaction (PROMIS depression r=0.3, PROMIS Anxiety r=0.3). Preoperative mental health did not correlate with postoperative satisfaction. CONCLUSIONS Postoperative PROMIS depression and anxiety moderately correlate with postoperative NASS satisfaction in surgical cervical patients, with worse postoperative mental health correlated with worse satisfaction. Preoperative depression and anxiety do not correlate with postoperative satisfaction. Addressing mental health concerns for operative cervical patients, particularly in the postoperative period, may increase satisfaction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

PROMIS CAT forms demonstrate responsiveness in patients following arthroscopic rotator cuff repair across numerous health domains

Recent studies of patients with rotator cuff tears have demonstrated improved efficiency with Patient-Reported Outcomes Measurement Information System (PROMIS) when compared with traditional patient-reported outcome measures (PROM). However, these studies have been cross-sectional in nature and the responsiveness of PROMIS computer adaptive test (CAT) forms has not been evaluated. The purpose of this study was to determine the responsiveness of PROMIS CAT assessments in patients undergoing arthroscopic rotator cuff repair. All patients undergoing arthroscopic rotator cuff repair by one of 3 fellowship-trained surgeons were included in the study. PROMIS CAT upper extremity physical function ("PROMIS-UE"), pain interference ("PROMIS-PI"), and depression ("PROMIS-D") scores from preoperative and 6-month postoperative visits were collected and analyzed. Patient-centric demographic factors, tear size, and biceps involvement were also correlated to preoperative and postoperative PROMIS scores. A total of 101 patients were enrolled in the study. The average age was 59.8 ± 8.9 years with 51 males (50.5%). Preoperative PROMIS-UE, PROMIS-PI, and PROMIS-D CAT scores improved significantly from 29.8 ± 6.0, 62.6 ± 5.1, and 48.4 ± 8.7, respectively, to 40.9 ± 9.8, 51.2 ± 9.3, and 42.9 ± 9.0, respectively, at 6-month follow-up (P < .001). Preoperative correlations were found between PROMIS-UE and PROMIS-PI scores (P < .001) and between PROMIS-PI and PROMIS-D scores (P = .001). No significant correlation was found between PROMIS-UE and PROMIS-D scores (P = .08), preoperatively. Preoperative PROMIS-UE, PROMIS-PI, or PROMIS-D scores were not correlated with rotator cuff tear size (P = .4). PROMIS CAT forms demonstrate responsiveness in patients undergoing arthroscopic rotator cuff repair across numerous domains.