دورية أكاديمية

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making.

التفاصيل البيبلوغرافية
العنوان: An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making.
المؤلفون: McGirt MJ; Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina., Bydon M; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota., Archer KR; Department of Orthopedic Surgery, Vanderbilt Spine Center.; Department of Physical Medicine and Rehabilitation, and., Devin CJ; Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee., Chotai S; Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee., Parker SL; Department of Orthopedic Surgery and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, Tennessee., Nian H; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Harrell FE Jr; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Speroff T; Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, Tennessee.; Departments of Medicine and Biostatistics, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee., Dittus RS; Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, Tennessee.; Departments of Medicine and Biostatistics, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee., Philips SE; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Shaffrey CI; Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and., Foley KT; Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee., Asher AL; Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina.
المصدر: Journal of neurosurgery. Spine [J Neurosurg Spine] 2017 Oct; Vol. 27 (4), pp. 357-369. Date of Electronic Publication: 2017 May 12.
نوع المنشور: Journal Article; Multicenter Study
اللغة: English
بيانات الدورية: Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 101223545 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1547-5646 (Electronic) Linking ISSN: 15475646 NLM ISO Abbreviation: J Neurosurg Spine Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Charlottesville, VA : American Association of Neurological Surgeons, c2004-
مواضيع طبية MeSH: Decision Making*, Lumbar Vertebrae/*surgery , Spinal Diseases/*surgery, Aged ; Back Pain/diagnosis ; Back Pain/epidemiology ; Back Pain/surgery ; Databases, Factual ; Disability Evaluation ; Female ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/epidemiology ; Prognosis ; Prospective Studies ; Quality of Life ; Registries ; Sensitivity and Specificity ; Socioeconomic Factors ; Spinal Diseases/diagnosis ; Spinal Diseases/epidemiology ; Treatment Outcome
مستخلص: OBJECTIVE Quality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery. METHODS Included in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers' compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO. RESULTS There was a significant improvement in all PROs (p < 0.0001) at 12 months following lumbar spine surgery. The most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers' compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes). CONCLUSIONS This study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.
فهرسة مساهمة: Keywords: ASA = American Society of Anesthesiologists; BMI = body mass index; BP = back pain; CAD = coronary artery disease; CI = confidence interval; IQR = interquartile range; LP = leg pain; MCID = minimal clinically important difference; NRS = numeric rating scale; ODI = Oswestry Disability Index; OR = odds ratio; PRO = patient-reported outcome; QOD; QOD = Quality Outcomes Database; QOL = quality of life; Quality Outcomes Database; disability; lumbar; pain; patient-reported outcomes; predictive model; quality of life
تواريخ الأحداث: Date Created: 20170513 Date Completed: 20171006 Latest Revision: 20220410
رمز التحديث: 20221213
DOI: 10.3171/2016.11.SPINE16526
PMID: 28498074
قاعدة البيانات: MEDLINE
الوصف
تدمد:1547-5646
DOI:10.3171/2016.11.SPINE16526