Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1331-1338. doi: 10.1097/BRS.0000000000002087.
Retrospective analysis of prospectively collected data.
The aim of this study was to determine whether 1-year patient-reported outcomes (PROs) can accurately assess effective care for patients undergoing surgery for degenerative lumbar spine disease.
Prospective longitudinal PROs registries provide a means to accurately assess outcomes and determine the relative effectiveness of various spine treatments. Obtaining long-term PROs can be costly and challenging.
Patients enrolled into a prospective registry who underwent lumbar spine surgery for degenerative disease were included. Baseline, 1-year, and 2-year Oswestry Disability Index (ODI) scores were captured. Previously published minimum clinically important difference (MCID) for ODI (14.9) was used. Multivariable linear regression model was created to derive model-estimated 2-year ODI scores. Absolute differences between 1-year and 2-year ODI were compared to absolute differences between 2-year and model-estimated 2-year ODI. Concordance rates in achieving MCID at 1-year and 2-year and predictive values were calculated.
A total of 868 patients were analyzed. One-year ODI scores differed from 2-year scores by an absolute difference of 9.7 ± 8.9 points and predictive model-estimated 2-year scores differed from actual 2-year scores by 8.8 ± 7.3 points. The model-estimated 2-year ODI was significantly different than actual 1-year ODI in assessing actual 2-year ODI for all procedures (P = 0.001) except for primary (P = 0.932) and revision microdiscectomy (P = 0.978) and primary laminectomy (P = 0.267). The discordance rates of achieving or not achieving MCID for ODI ranged from 8% to 27%. Concordance rate was about 90% for primary and revision microdiscectomy. The positive and negative predictive value of 1-year ODI to predict 2-year ODI was 83% and 67% for all procedures and 92% and 67% for primary and 100% and 86% for revision microdiscectomy respectively.
One-year disability outcomes can potentially estimate 2-year outcomes for patient populations, but cannot reliably predict 2-year outcomes for individual patients, except for patients undergoing primary and revision microdiscectomy.
前瞻性收集数据的回顾性分析。
本研究旨在确定 1 年患者报告的结局（PROs）是否能准确评估退行性腰椎疾病患者接受手术治疗的有效护理。
前瞻性纵向 PROs 登记处提供了一种准确评估结局和确定各种脊柱治疗方法相对有效性的方法。获得长期 PROs 可能既昂贵又具有挑战性。
纳入参与前瞻性登记处并因退行性疾病接受腰椎手术的患者。记录基线、1 年和 2 年 Oswestry 残疾指数（ODI）评分。使用先前发表的 ODI 的最小临床重要差异（MCID）（14.9）。创建多变量线性回归模型，以推导出模型估计的 2 年 ODI 评分。比较 1 年和 2 年 ODI 的绝对差值与 2 年和模型估计的 2 年 ODI 的绝对差值。计算 1 年和 2 年达到 MCID 的一致性率和预测值。
共分析了 868 例患者。1 年 ODI 评分与 2 年评分的绝对差值为 9.7±8.9 分，预测模型估计的 2 年评分与实际 2 年评分的绝对差值为 8.8±7.3 分。除了原发性（P=0.932）和翻修显微椎间盘切除术（P=0.978）以及原发性椎板切除术（P=0.267）外，该模型估计的 2 年 ODI 在评估所有手术的实际 2 年 ODI 方面明显优于实际 1 年 ODI（P=0.001）。达到或未达到 ODI MCID 的不一致率为 8%至 27%。原发性和翻修显微椎间盘切除术的一致性率约为 90%。1 年 ODI 预测 2 年 ODI 的阳性和阴性预测值分别为所有手术的 83%和 67%，原发性和翻修显微椎间盘切除术的 92%和 67%。
