Introduction: 30% of U.S. healthcare expenditures support care that is ineffective in real-world(non-research) settings. Efficacious treatments in research settings often fail to prove effective at the individual-patient level when applied in everyday-care settings. Prospective patient-reported-outcome(PRO) registries measuring this wide spectrum of care may allow for identification of optimized care paradigms, refine surgical delivery, and demonstrate the value of spine surgery.
Methods: A nationwide, web-based, prospective, longitudinal one-year outcomes registry was introduced into 49 spine practices. Using standardized process of representative sampling, baseline, peri-operative, 3-and 12-month medical record and PRO was entered prospectively for five surgical spine diagnoses.
Results: To date, 37sites with 236surgeons from 29US states have enrolled 7951patients [2743(34.8%) disc herniation, 2678(34.0%) stenosis, 1549(19.6%) spondylolisthesis, 487(6.2%) recurrent-disc herniation, 426(5.4%) adjacent segment disease],Table-1. Of 7951patients enrolled, 4970 have passed 3mo follow-up with 81% follow-up rate and 1822 have passed 12mo with 74% follow-up rate. Mean pain (VAS-LP:6.9 vs2.6, VAS-BP:6.5 vs3.3), disability (ODI:49.8 vs 25.3), and quality-of-life (EQ5D:0.54 vs 0.76) were improved 12mo post-operatively,(P<0.001),Figure-1A. However, 194(11%)patients reported no improvement in ODI(ranging 8-17% per diagnosis) and 536(29.4%) failed to achieve a minimum-clinical-important-difference(MCID) level of improvement in ODI(range:24-48% per diagnosis)Figure-1B. Only 65% of patients reported outcome met expectations and 12%would not undergo surgery again. Lack of college degree, smoking, depression, back dominant symptoms, a prior spine surgery, workers comp or liability/disability claim, and symptom duration >3mo were associated with failure to achieve MCID 12mo after lumbar surgery. Patients with 2(OddsRatio:1.2), 3-4(OR:2.1) or =5(OR:2.9) of these pre-operative characteristics had increasing odds of treatment failure, Figure-2&Table-2.
Conclusions: Lumbar surgery was effective at improving pain, disability, and quality-of-life for five common lumbar diagnoses. Significant variability exists in effectiveness of surgical care at individual-patient level, and many patients experience little to no benefit from surgery in current real-world practice paradigms. Individual patient profiles may identify patients least likely to improve.
Patient Care: Our study demonstrates that significant variability exists in effectiveness of surgical care at individual-patient level, and many patients experience little to no benefit from surgery in current real-world practice paradigms. Individual patient profiles may identify patients least likely to improve.
Learning Objectives: At the end of the session, participants should be able to: 1) Understand that in a nation-wide registry, lumbar surgery is effective in improving pain, disability and quality of life; 2) Determine that significant variability exists in effectiveness of surgical care at individual-patient level