Newswise — WASHINGTON, D.C. (May 4, 2015) — Matthew Joseph McGirt, MD, FAANS, presented his research, Patient Reported Outcomes 3-Months after Spine Surgery: Is it an Accurate Predictor of 12-Month, during the 2015 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in health-care delivery. The researchers set out to determine whether three-month patient reported outcomes accurately predict 12-month outcomes, and hence, whether three-month measurement systems suffice to identify effective versus non-effective spine care.
All patients undergoing lumbar spine surgery for degenerative disease at a single institution over a two-year period were enrolled in a prospective longitudinal registry. Patient reported outcome instruments were recorded prospectively at baseline, three months and 12 months, postoperatively. Receiver operating characteristic (ROC) curve analysis performed to determine whether improvement in general health state (EQ-5D) and disability (ODI) at three months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months.
The study included 593 patients. There was correlation between three- and 12-month EQ-5D (r=0.71;p<0.0001) and ODI (r=0.70;p<0.0001); however, researchers observed sizable discrepancy in achievement of a clinically significant improvement (MCID) threshold at three versus 12 months on the individual patient level. For postoperative disability (ODI), 11.5 percent of patients that achieved MCID threshold at three months dropped below threshold at 12 months; and, 10.5 percent of patients who did not meet MCID threshold at three months surpassed MCID threshold at 12 months. For ODI, achieving MCID at three months accurately predicted 12 month MCID with only 62.6-percent specificity and 86.8- percent sensitivity.
For postoperative health utility (EQ-5D), 8.5 percent of patients lost MCID threshold improvement from three to 12 months, while 4.0 percent gained MCID threshold between three and 12 months postoperatively. For EQ-5D (quality adjusted life years), achieving MCID at three months accurately predicted 12 month MCID with only 87.7-percent specificity and 87.2-percent sensitivity.
Patient-reported measures of treatment effectiveness obtained at three months correlated with 12 month measures overall in aggregate, but did not reliably predict 12-month outcome at the patient-level. Prospective longitudinal spine outcomes registries need to span at least 12 months to identify effective versus non-effective patient care.
Author Block: Scott Parker, MD; Anthony L. Asher, MD, FAANS; Saniya S. Godil, MD; Clinton J. Devin
Disclosure: The author reported no conflicts of interest.
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About the 2015 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. More than 1,200 scientific abstracts were presented for review at the 2015 AANS Annual Scientific Meeting, and the scientific presentations given at this year’s event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Additional information about the 2015 AANS Annual Scientific Meeting and the meeting program can be found here.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 9,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada, or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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