Preoperative patient-reported outcome score thresholds predict the likelihood of reaching MCID with surgical correction of adult spinal deformity

Andrea Leyton-Mange, Eeric Truumees, Kevin J. Bozic, Devender Singh, Tiffany C. Liu, John K. Stokes, Michael J. Mahometa, Matthew J. Geck

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background context: Preoperative (pre-op) identification of patients likely to achieve a clinically meaningful improvement following surgery for adult spinal deformity (ASD) is critical, especially given the substantial cost and comorbidity associated with surgery. Even though pain is a known indication for surgical ASD correction, we are not aware of established thresholds for baseline pain and function to guide which patients have a higher likelihood of improvement with corrective surgery. Purpose: We aimed to establish pre-op patient-reported outcome measure (PROM) thresholds to identify patients likely to improve by at least one minimum clinically important difference (MCID) with surgery for ASD. Study design: This is a retrospective cohort study using prospectively collected data. Patient sample: We reviewed 172 adult patients’ charts who underwent corrective surgery for spinal deformity. Outcome measures: Included measures were the Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22). Our primary outcome of interest was improvement by at least one MCID on the ODI and SRS-22 at 2 years after surgery. Methods: As part of usual care, the VAS, ODI, and SRS-22 were collected pre-op and re-administered at 1, 2, and 5 years after surgery. MCIDs were calculated using a distribution-based method. Determining significant predictors of MCID at two years was accomplished by Firth bias corrected logistic regression models. Significance of predictors was determined by Profile Likelihood Chi-square. We performed a Youden analysis to determine thresholds for the strongest pre-op predictors. Results: At year two, 118 patients (83%) reached MCID for the SRS and 127 (75%) for the ODI. Lower pre-op SRS overall, lower pre-op SRS pain, and higher pre-op SRS function predicted a higher likelihood of reaching MCID on the overall SRS (p < 0.05). Higher pre-op ODI, lower SRS pain and self-image, and higher SRS overall predicted a higher likelihood of reaching MCID on the ODI (p < 0.05). An ODI threshold of 29 predicted reaching MCID with a sensitivity of 0.89 and a specificity of 0.64 (AUC = 0.7813). An SRS threshold of 3.89 predicted reaching MCID with a sensitivity of 0.93 and specificity of 0.68 (AUC = 0.8024). Conclusions: We identified useful thresholds for ODI and SRS-22 with acceptable predictive ability for improvement with surgery for ASD. Pre-op ODI, SRS, and multiple SRS subscores are predictive of meaningful improvement on the ODI and/or SRS at 2 years following corrective surgery for spinal deformity. These results highlight the usefulness of PROMs in pre-op shared decision-making.

Original languageEnglish
Pages (from-to)207-219
Number of pages13
JournalSpine Deformity
Volume9
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • Adult spinal deformity
  • Oswestry disability index
  • Patient-reported outcome measures
  • Predictive model
  • Risk stratification
  • SRS-22
  • Spine surgery
  • VAS

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