Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Newton Wellesley Hospital, Newton, MA, USA.
Spine J. 2021 Mar;21(3):397-404. doi: 10.1016/j.spinee.2020.10.026. Epub 2020 Oct 31.
The ability to preoperatively predict which patients will achieve a minimal clinically important difference (MCID) after lumbar spine decompression surgery can help determine the appropriateness and timing of surgery. Patient-Reported Outcome Measurement Information System (PROMIS) scores are an increasingly popular outcome instrument.
The purpose of this study was to develop algorithms predictive of achieving MCID after primary lumbar decompression surgery.
This was a retrospective study at two academic medical centers and three community medical centers including adult patients 18 years or older undergoing one or two level posterior decompression for lumbar disc herniation or lumbar spinal stenosis between January 1, 2016 and April 1, 2019.
The primary outcome, MCID, was defined using distribution-based methods as one half the standard deviation of postoperative patient-reported outcomes (PROMIS physical function, pain interference, pain intensity).
Five machine learning algorithms were developed to predict MCID on these surveys and assessed by discrimination, calibration, Brier score, and decision curve analysis. The final model was incorporated into an open access digital application.
Overall, 906 patients completed at least one PROMs survey in the 90 days before surgery and at least one PROMs survey in the year after surgery. Attainment of MCID during the study period by PROMIS instrument was 74.3% for physical function, 75.8% for pain interference, and 79.2% for pain intensity. Factors identified for preoperative prediction of MCID attainment on these outcomes included preoperative PROs, percent unemployment in neighborhood of residence, comorbidities, body mass index, private insurance, preoperative opioid use, surgery for disc herniation, and federal poverty level in neighborhood of residence. The discrimination (c-statistic) of the final algorithms for these outcomes was 0.79 for physical function, 0.74 for pain interference, and 0.69 for pain intensity with good calibration. The open access digital application for these algorithms can be found here: https://sorg-apps.shinyapps.io/promis_pld_mcid/ CONCLUSION: Lower preoperative PROMIS scores, fewer comorbidities, and certain sociodemographic factors increase the likelihood of achieving MCID for PROMIS after lumbar spine decompression.
术前预测哪些患者在腰椎减压手术后将达到最小临床重要差异（MCID），有助于确定手术的适宜性和时机。患者报告的结局测量信息系统（PROMIS）评分是一种越来越受欢迎的结局工具。
本研究旨在开发预测原发性腰椎减压手术后达到 MCID 的算法。
这是一项在两个学术医疗中心和三个社区医疗中心进行的回顾性研究，纳入了 2016 年 1 月 1 日至 2019 年 4 月 1 日期间接受单节段或双节段后路减压治疗腰椎间盘突出症或腰椎椎管狭窄症的 18 岁及以上成年患者。
主要结局 MCID 定义为术后患者报告结局（PROMIS 躯体功能、疼痛干扰、疼痛强度）的标准差的一半。
开发了 5 种机器学习算法来预测这些调查中的 MCID，并通过判别、校准、Brier 评分和决策曲线分析进行评估。最终模型被纳入一个开放获取的数字应用程序中。
总体而言，906 例患者在手术前 90 天内至少完成了一次 PROMs 调查，在手术后一年内至少完成了一次 PROMs 调查。在研究期间，PROMIS 工具达到 MCID 的比例为躯体功能 74.3%、疼痛干扰 75.8%和疼痛强度 79.2%。术前预测这些结局达到 MCID 的因素包括术前 PRO、居住地附近的失业率、合并症、体重指数、私人保险、术前阿片类药物使用、椎间盘突出症手术以及居住地附近的联邦贫困水平。这些结局的最终算法的判别（c 统计量）为躯体功能 0.79、疼痛干扰 0.74 和疼痛强度 0.69，具有良好的校准。这些算法的开放获取数字应用程序可在此处找到：https://sorg-apps.shinyapps.io/promis_pld_mcid/
术前 PROMIS 评分较低、合并症较少以及某些社会人口因素增加了腰椎减压术后达到 PROMIS MCID 的可能性。
