Introduction: Recently, the use of Patient Reported Outcomes (PROs) as measures of surgical effectiveness and hospital management has been increasingly popular. In spine surgery especially, quality and longitudinal assessment of subjective and objective outcomes are becoming used more frequently used as measures of success. However, prospectively obtaining longitudinal outcomes for patients’,12 months after spine surgery remains a challenge. Furthermore, identifying potential negative post-operative trajectories will reduce 30-day readmission rates and increase patient satisfaction. The aim of this study was to assess whether immediate post-operative neck-pain measures accurately predict long-term VAS-NP outcomes (12-months).
Methods: The medical records of 82 patients undergoing elective spine surgery at a major academic medical center were reviewed. All patients had retrospectively collected outcomes measures and a minimum of 1-year follow up. Patient reported outcomes instrument (VAS-Neck Pain) was completed before surgery, then at 3, 6, and 12-months after surgery. Furthermore, patients provided a post-operative pain score immediately after ACDF procedure. Multivariate correlation and logistic regression methods were performed to determine if immediate post-operative pain score accurately predicted 1-year patient reported VAS-NP Scores.
Results: Patient demographics of the cohort were 46.34% male, 25.61% were smokers, and the mean ± standard deviation Age and Body Mass Index (BMI) were 53.74±12.50 and 28.28±7.01, respectively,Table 1. The median[IQR] fusion levels for the cohort was 2[1-3], and surgical site infection was the most common post-operative complication at 3.7%,Table 1. There were significant correlations between immediate post-operative pain score and 6-week VAS-NP (r=0.4114,p=0.0015), 6-month VAS-NP (r=0.3291,p=0.0333), and 12-months VAS-NP (r=0.3503,p=0.0247),Table 2. Similarly, in a multivariate regression model predicting VAS-NP outcomes at 6-weeks, 3-,6-, and 12-month outcomes from immediate post-operative pain scores were significant for 6-weeks (p=0.0063), 6-months (p=0.0145), and 12-months (p=0442),Table 3.
Conclusions: Our study suggests that immediate post-operative patient reported pain scores independently predicts and correlates with long-term VAS-NP scores 12-months after ACDF surgery.
Patient Care: Our research identify patients at risk of worsening longterm VAS pain scores and brings-to-front a measure that predicts longterm outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of assessing immediate post-operative pain scores.
2) Discuss, in small groups, how to identify patients that are at risk of worsening longterm VAS pain scores.
3) Identify treatments regimens that reduce immediate post-operative pain scores.