Evaluation of Health-related Quality of Life Improvement in Patients Undergoing Spine Versus Adult Reconstructive Surgery

Abstract

Study Design. Retrospective analysis of outcomes in single-level spine and primary hip and knee arthroplasty patients. Objective. The aim of this study was to compare baseline and postoperative outcomes in patients undergoing spine surgery procedures with total hip arthroplasty (THA) and total knee arthroplasty (TKA) to further define outcomes in orthopedic surgery. Summary of Background Data. Computer-adaptive Patient Reported Outcome Information System (PROMIS) allows for standardized assessment of the health-related quality of life across different disease states. Methods. Patients who underwent spine surgery (anterior cervical discectomy and fusion, cervical disc replacement, lumbar laminectomy, microscopic lumbar discectomy, transforaminal lumbar interbody fusion or adult reconstruction surgery [THA, TKA]) were grouped. Mean Charlson Comorbidity Index (CCI), Baseline (BL), and 6-month PROMIS scores of physical function, pain interference, and pain intensity were determined. Paired t tests compared differences in CCI, BL, 6 months, and change in PROMIS scores for spine and adult reconstruction procedures. Results. A total of 304 spine surgery patients (age = 58.1 ± 15.6; 42.9% female) and 347 adult reconstruction patients (age = 62.9 ± 11.8; 54.1% Female) were compared. Spine surgery groups had more disability and pain at baseline than adult reconstruction patients according to physical function ([21.0, 22.2, 9.07, 12.6, 10.4] vs. [35.8, 35.0], respectively, P < 0.01), pain interference ([80.1, 74.1, 89.6, 92.5, 90.6] vs. [64.0, 63.9], respectively, P < 0.01), and pain intensity ([53.0, 53.1, 58.3, 58.5, 56.1] vs. [53.4, 53.8], respectively, P < 0.01). At 6 months, spine surgery patients remained more disabled and had more pain compared to adult reconstruction patients. Over the 6-month timespan, spine patients experienced greater improvements than adult reconstruction patients in terms of physical function ([+8.7, +22.2, +9.7, +12.9, +12.1] vs. [+5.3, +3.9], respectively, P < 0.01) and pain interference scores ([−15.4,−28.1, −14.7, −13.1, −12.3] vs. [−8.3, −6.0], respectively, P < 0.01). Conclusion. Spinal surgery patients had lower BL and 6-month PROMIS scores, but greater relative improvement in PROMIS scores compared to adult reconstruction patients. Level of Evidence: 3

Single-level Lumbar Fusion Versus Total Joint Arthroplasty: A Comparison of 1-year Outcomes

“…Thus, it may be expected that patient-reported physical function would be greater for TJA patients in the immediate postoperative period as demonstrated by a retrospective study comparing TLIF patients with THA or TKA patients, which found markedly worse patient-reported physical function for TLIF patients at 6 months. 15 Baseline MCS-12 scores for all three cohorts in our study were comparable with current literature. 16,24,26 Despite differences in preoperative and postoperative MCS-12 scores between cohorts, no differences in DMCS-12 scores or RR were found on univariate analysis.…”

“…3,4 Our results indicate that all three patient cohorts experienced notable improvements in 1-year HRQOL measures compared with preoperative baseline scores, which is consistent with currently available high-quality studies. [15][16][17] However, the greatest improvements in clinical outcomes were found among THA patients, followed subsequently by TKA and LF patients. THA and TKA patients markedly improved for pain, disability, and physical function at 1 year postoperatively in our analysis.…”

“…Thus, it may be expected that patient-reported physical function would be greater for TJA patients in the immediate postoperative period as demonstrated by a retrospective study comparing TLIF patients with THA or TKA patients, which found markedly worse patient-reported physical function for TLIF patients at 6 months. 15…”

Evaluation of Health-related Quality of Life Improvement in Patients Undergoing Cervical Versus Shoulder Surgery

“…[20][21][22][23][24] The introduction of computer-adaptive Patient-reported Outcome Information System (PROMIS) scores as a tool for assessing across health conditions enables comparison between different diagnoses and orthopedic procedures. [25][26][27] In this study, we directly compare improvements in pain and functional status for patients undergoing cervical spine surgery with arthroscopic shoulder surgery using the PROMIS metric. In addition, we compare pain and functional outcomes for cervical spine surgery patients with comorbid shoulder pain with arthroscopic shoulder surgery patients with comorbid neck pain.…”

Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra

“…2 Our understanding and treatment of adult spinal deformity (ASD) has grown exponentially over the past several decades-several studies have demonstrated improved healthrelated quality of life (HRQOL) after surgical intervention. [3][4][5] However, these gains do not occur without significant healthcare cost-the economic consequences associated with management of ASD are substantial. As a result, optimizing our treatment of ASD is vital as we strive to improve patient outcomes and decrease costs.…”