Introduction: Quality and outcomes registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in healthcare delivery. However, obtaining outcomes data from patients 12 months after spine surgery remains a challenge. We set out to determine whether 3-month patient reported outcomes(PROs) accurately predict 12-month outcomes.
Methods: Patients undergoing spine surgery for degenerative spine disease over a two-year period were enrolled in a prospective longitudinal registry. PROs(NRS, ODI, NDI, SF-12, EQ-5D and Zung Depression) were recorded prospectively at baseline, 3-months and 12-months. Linear regression was performed to determine the independent association of three and twelve month outcome. ROC curve analysis was performed to determine whether improvement in general health state(EQ-5D) and disability(ODI/NDI) at 3-months accurately predicted improvement and achievement of MCID at 12-month.
Results: A total of 700 patients were included(Lumbar=593;Cervical=107). There was a significant correlation between 3-mo and 12-mo EQ-5D(r=0.71; p<0.0001) and ODI/NDI(r=0.70; p<0.0001). After adjustment, 3-month PROs remained independently associated with 12-month scores(p<0.001). For ODI/NDI, achieving MCID at 3-months accurately predicted 12-month MCID with only 62.6% specificity and 86.8% sensitivity for lumbar surgery and 43.8% specificity and 92.3% sensitivity for cervical surgery,Figure 2. For EQ5D, achieving MCID at 3-months accurately predicted 12-month MCID with only 87.7% specificity and 87.2% sensitivity for lumbar and 81.9% specificity and 82.1% sensitivity for cervical surgery,Figure 2. Three-month outcome remained a poorly accurate marker for 12-month outcome for all lumbar and cervical surgery subsets,Figure 3.
Conclusions: In a prospective registry, PROs at 3 months do not reliably predict outcomes 12-month after spine surgery. Many patients failing to benefit from surgery by 3months do so by 12months. Many patients reporting meaningful improvement by 3 months report loss of benefit at 12months. Prospective longitudinal spine outcomes registries need to span at least 12months to identify effective versus non-effective patient care.
Patient Care: Our research highlights that outcomes at 3 months do not reliably predict outcomes 12-month after spine surgery. Therefore, prospective longitudinal spine outcomes registries need to span at least 12months to identify effective versus non-effective patient care.
Learning Objectives: At the end of the session, participants should be able to: 1) Understand the correlation between 3-month and 12-month patient reported outcomes; 2) Determine that PROs at 3 months do not reliably predict outcomes 12-month after spine surgery; 3) Understand that prospective longitudinal spine outcomes registries need to span at least 12months to identify effective versus non-effective patient care.