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  • Patient Characteristics That Increase Likelihood of Achieving ODI MCID Up to Two-Years After Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative

    Final Number:

    Hesham Mostafa Zakaria MD; Michael Bazydlo MS; Shujie Xiao MS; Lonnie Schultz PhD; Jason M. Schwalb MD FAANS FACS; Paul Park MD; David Nerenz PhD; Victor W. Chang MD; For the MSSIC Investigators

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: With the increasing frequency of spine surgery,1-6 there is an important need to demonstrate the effectiveness of these procedures to provide clinical benefit.7, 8 Patient reported outcomes (PROs) have become the standard measurement of recording outcomes, with achieving a minimally clinically important difference (MCID) of the PRO being considered a successful surgery. We sought to identify which patient characteristics increase the likelihood of achieving Oswestry Disability Index (ODI) MCID after lumbar spine surgery.

    Methods: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide multicenter quality improvement collaborative.9 Using MSSIC, we identified 4293 at 90d, 2408 patients at 1yr, and 826 patients at 2yr with complete ODI data. Multivariate logistic regression models were constructed to identify risk factors for achieving MCID. MCID was defined as a change of ODI of 13.5 points or more.

    Results: At 90d follow-up, 61.31% achieved ODI MCID. At 1yr follow-up, 64.91% achieved MCID. At 2yr follow-up, 64.53% achieved MCID. Factors that decreased likelihood of achieving ODI MCID at 90d, 1yr, and 2yrs include lower baseline ODI (p<0.001), higher baseline back pain score (p<0.004), liability (p<0.05), previous spine fusion (p<0.001), tobacco usage (p<0.033), opioid usage =6mo (p<0.002), and depression (p=0.002). Factors that decreased likelihood of achieving OD MCID at 90d and 1yr include unemployment (p=0.009), decreasing education (p<0.05), previous spine surgery (p<0.003), anxiety (p<0.04), ASA>2 (p=0.006), and symptoms =3mo (p<0.001). Factors that decreased likelihood of achieving ODI MCID at 90d only include younger age (p=0.002), workman’s comp (p=0.009), African American race (p<0.001), and osteoporosis (p<0.001). A BMI=30 decreased the likelihood of achieving MCID at 2yrs only.

    Conclusions: We identified patient characteristics that influence the likelihood of achieving MCID. Knowledge of these characteristics is important to get a better understanding of which patients are more likely to have better outcome after surgery.

    Patient Care: My research will improve patient care by identifying which patients are more likely to have a better outcome after lumbar spine surgery.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of minimally clinically important difference (MCID) 2) Describe which patient demographic factors increase or decrease likelihood of achieving ODI MCID

    References: 1. Taylor VM, Deyo RA, Cherkin DC, Kreuter W. Low back pain hospitalization. Recent United States trends and regional variations. Spine (Phila Pa 1976). Jun 01 1994;19(11):1207-1212; discussion 1213. 2. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. Apr 07 2010;303(13):1259-1265. 3. Rajaee SS, Kanim LE, Bae HW. National trends in revision spinal fusion in the USA: patient characteristics and complications. Bone Joint J. Jun 2014;96-B(6):807-816. 4. Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J. Feb 01 2015;15(2):265-271. 5. Sivasubramaniam V, Patel HC, Ozdemir BA, Papadopoulos MC. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study. BMJ Open. Dec 15 2015;5(12):e009011. 6. Bernstein DN, Brodell D, Li Y, Rubery PT, Mesfin A. Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013. Global Spine J. May 2017;7(3):213-219. 7. Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med. Apr 14 2016;374(15):1424-1434. 8. Forsth P, Olafsson G, Carlsson T, et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med. Apr 14 2016;374(15):1413-1423. 9. Chang V, Schwalb JM, Nerenz DR, et al. The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative. Neurosurg Focus. Dec 2015;39(6):E7.

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