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  • The Effect of Patient Age on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-year Follow-Up: A Novel Area Under the Curve Analysis

    Final Number:

    Justin K Scheer BS; Justin S. Smith MD PhD; Gregory Mundis MD; Eric Klineberg MD; Robert Hart MD; Michael P Kelly; Vedat Deviren MD; Stacie Nguyen MPH; Ian McCarthy PhD; Shay Bess MD; Frank Schwab MD, PhD; Christopher I. Shaffrey MD, FACS; Virginie Lafage PhD; Christopher P. Ames MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Elderly patients (pts) with adult spinal deformity (ASD) have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited to static time points perhaps diminishing the health impact of the entire postoperative recovery experience. This study aims to identify the effect of age on the recovery kinetics by examining the effect of HRQOL over time via an area under the curve analysis (AUC).

    Methods: A retrospective review of a multicenter, prospective ASD database. Inclusion criteria, =18yrs, ASD. Pts were stratified by the following age groups: =45yrs, 46-64, 65-74, =75. HRQOL collected included Oswestry Disability Index (ODI), Short Form-36(PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6wks, 1 and 2yrs postop. All HRQOL was normalized to each patients’ baseline scores as a comparison relative to where the patients started. An AUC was then calculated across the entire 2yrs. Standard HRQOL and AUC means were compared between groups.

    Results: 149 pts met inclusion criteria (=45:32, 46-64:67, 65-74:38, =75:12). Older pts had significantly worse preop ODI, PCS, SRS activity, pain and total compared with their respective younger age groups (p<0.05 for all) with the exception of 65-74 vs =75 and 46-64 vs 65-74 (p>0.05 for all). All age groups significantly improved all HRQOL at 2yrs compared with preop (p<0.05 for all) except SRS mental and MCS for all age groups and ODI and SRS Activity for =45 (p>0.05). However, normalized 2 year AUC HRQOL for the younger pts was worse than their respective older age groups for ODI, PCS, SRS Activity, pain and total.

    Conclusions: Based on static HRQOL analysis, all age groups improved HRQOL at 2yrs following surgery with older pts having worse preop HRQOL than younger pts. AUC analysis, however, suggests that the recovery kinetics is significantly worse for younger pts than the older pts.

    Patient Care: This research will improve patient care by allowing further clarification of the postoperative recovery process which can aid in patient education and setting of expectations.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Apreciate that an AUC analysis provides additional information to patients recovery kinetics than static HRQOL outcomes, 2) understand that the postop recovery process varyies based on age, and 3) Older pts have a shorter and improved recovery period compared to younger patients when normalized to their own preop baselines.


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