Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study

Abstract

Introduction: Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measured preoperatively with the commonly used Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) questionnaires. We aim to identify (1) the preoperative relationship between HOOS/KOOS and VR-12 scores and several demographic, psychosocial, and clinical patient characteristics and (2) the best modifiable factors for optimization, which may result in improved baseline PROs before TJR. Methods: All TJR cases performed in 2017 at the two highest-volume hospitals within an urban academic health system were queried. Preoperative HOOS/KOOS and VR-12 surveys were administered through an e-collection platform. VR-12 physical and mental component scores (PCS, MCS) were generated. Patient information was extracted from the electronic health record. Bivariate and multivariate regression analyses were performed. Odds ratios (ORs) and 95% confidence intervals were reported. Results: In univariate analysis, patients with HOOS/KOOS, VR-12 PCS, and MCS in the ≤25th percentile group were more likely to have an ASA score of ≥3 compared with those with higher scores. In multivariate analysis, increased and decreased odds of low HOOS/KOOS were associated with a one-unit increase in Charlson Comorbidity Index (OR, 1.16) and VR-12 MCS (OR, 0.97), respectively. Increased odds of low baseline VR-12 PCS and MCS were associated with ASA class ≥3 (OR, 1.65 and 1.40). Decreased odds of a low MCS were associated with an increase in HOOS/KOOS (OR, 0.98) ( P ≤ 0.05 for all). Conclusion: Of the factors that are associated with low baseline PRO scores, preoperatively addressing mismanaged comorbidities, mental health, and physical function were identified as the best modifiable factors for optimization, which may result in improved baseline PROs before TJR.

Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes

“…, physical impairment) are twice as likely to have poor outcomes, and those with extended preoperative pain, worse baseline disability, and worse health-related QOL are more likely to report deteriorating functional trajectories postoperatively 36 . These findings underlie a common theme: impaired preoperative health is associated with worse orthopedic patient-reported outcomes, functioning, and pain 37–40 …”

Validation of Veterans RAND 12-Item Physical Function Survey in Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…There has been a growing demand for measures that are inexpensive or freely available, applicable across a number of specialties, and easy to complete. As a result, use of metrics such as the VR-12 PCS has risen considerably in spine surgery, [28][29][30] other areas of orthopedic surgery, 31,32 and nonorthopedic elective surgeries. 33 However, the VR-12 PCS metric had yet to be formally validated among patients with degenerative pathology of the lumbar spine.…”

The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12)

“…Following total lower extremity joint replacement, a 1-point increase in the preoperative PCS or MCS score is associated with an 8% and 4% reduction in being in the worst (25th percentile score) Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) groups, respectively (Bienstock et al, 2019). In addition, a 1-point increase in baseline MCS is associated with a 3% reduction in the likelihood of having a worse HOOS-PS score 1 year after surgery (higher scores indicate worse hip function) following arthroscopic hip surgery for a labral tear (Lynch et al, 2021d).…”