The Patient-Reported Outcome Measurement Information System (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

Cole Bortz; Katherine E. Pierce; Haddy Alas; Avery Brown; Dennis Vasquez-Montes; Erik Wang; Christopher G. Varlotta; Dainn Woo; Edem J. Abotsi; Jordan Manning; Ethan W. Ayres; Bassel G. Diebo; Michael C. Gerling; Aaron J. Buckland; Peter G. Passias

doi:10.14444/8011

ABSTRACT

Background The Patient-Reported Outcome Measurement Information System (PROMIS) and legacy outcome measures like the Oswestry Disability Index (ODI) have not been compared for their sensitivity in reflecting the impact of perioperative complications and length of stay (LOS) in a surgical thoracolumbar population. The purpose of this study is to assess the strength of PROMIS and ODI scores as they correlate with LOS and complication outcomes of surgical thoracolumbar patients.

Methods Retrospective cohort study. Included: patients ≥18 years undergoing thoracolumbar surgery with available preoperative and 3-month postoperative ODI and PROMIS scores. Pearson correlation assessed the linear relationships between LOS, complications, and scores for PROMIS (physical function, pain intensity, pain interference) and ODI. Linear regression predicted the relationship between complication incidence and scores for ODI and PROMIS.

Results Included: 182 patients undergoing thoracolumbar surgery. Common diagnoses were stenosis (62.1%), radiculopathy (48.9%), and herniated disc (47.8%). Overall, 58.3% of patients underwent fusion, and 50.0% underwent laminectomy. Patients showed preoperative to postoperative improvement in ODI (50.2 to 39.0), 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 < .001). Mean LOS was 2.7 ± 2.8 days; overall complication rate was 16.5%. Complications were most commonly cardiac, neurologic, or urinary (all 2.2%). Whereas preoperative to postoperative changes in ODI did not correlate with LOS, changes in PROMIS pain intensity (r = 0.167, P = .024) and physical function (r = −0.169, P = .023) did. Complications did not correlate with changes in ODI or PROMIS score; however, postoperative scores for physical function (r = −0.205, P = .005) and pain interference (r = 0.182, P = .014) both showed stronger correlations with complication occurrence than ODI (r = 0.143, P = .055). Regression analysis showed postoperative physical function (R² = 0.037, P = .005) and pain interference (R² = 0.028, P = .014) could predict complications; ODI could not.

Conclusions PROMIS domains of physical function and pain interference better reflected perioperative complications and LOS than the ODI. These results suggest PROMIS may offer more utility as an outcomes assessment instrument.

Level of Evidence 3.

Footnotes

Disclosures and COI: The authors received no funding for this study and declare that there are no conflicts of interest related to the submitted work. Personal disclosures outside the submitted work: Dr. Michael C. Gerling reports personal consulting fees for Wolf Endoscopic, other financial or material support from CTL Medical, board or committee membership at Cervical Spine Research Society and American Academy of Orthopaedic Surgeons. Dr. Aaron J. Buckland reports personal consulting fees for NuVasive and Stryker. Dr. Peter G. Passias reports personal consulting fees for Medicrea and Spine Wave, speaking honoraria from Globus Medical and Zimmer, other support from Allosource, and research support from Cervical Spine Research Society.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS