与传统的腰椎退行性疾病手术结局指标相比，患者报告结局测量信息系统（PROMIS）能更好地反映住院时间和90天内并发症发生情况的影响。
The Patient-Reported Outcome Measurement Information System (PROMIS) Better Reflects the Impact of Length of Stay and the Occurrence of Complications Within 90 Days Than Legacy Outcome Measures for Lumbar Degenerative Surgery.
作者信息
Bortz Cole, Pierce Katherine E, Alas Haddy, Brown Avery, Vasquez-Montes Dennis, Wang Erik, Varlotta Christopher G, Woo Dainn, Abotsi Edem J, Manning Jordan, Ayres Ethan W, Diebo Bassel G, Gerling Michael C, Buckland Aaron J, Passias Peter G
机构信息
Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York.
Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, New York.
出版信息
Int J Spine Surg. 2021 Feb;15(1):82-86. doi: 10.14444/8011. Epub 2021 Feb 12.
BACKGROUND
The Patient-Reported Outcome Measurement Information System (PROMIS) and legacy outcome measures like the Oswestry Disability Index (ODI) have not been compared for their sensitivity in reflecting the impact of perioperative complications and length of stay (LOS) in a surgical thoracolumbar population. The purpose of this study is to assess the strength of PROMIS and ODI scores as they correlate with LOS and complication outcomes of surgical thoracolumbar patients.
METHODS
Retrospective cohort study. Included: patients ≥18 years undergoing thoracolumbar surgery with available preoperative and 3-month postoperative ODI and PROMIS scores. Pearson correlation assessed the linear relationships between LOS, complications, and scores for PROMIS (physical function, pain intensity, pain interference) and ODI. Linear regression predicted the relationship between complication incidence and scores for ODI and PROMIS.
RESULTS
Included: 182 patients undergoing thoracolumbar surgery. Common diagnoses were stenosis (62.1%), radiculopathy (48.9%), and herniated disc (47.8%). Overall, 58.3% of patients underwent fusion, and 50.0% underwent laminectomy. Patients showed preoperative to postoperative improvement in ODI (50.2 to 39.0), PROMIS physical function (10.9 to 21.4), pain intensity (92.4 to 78.3), and pain interference (58.4 to 49.8, all < .001). Mean LOS was 2.7 ± 2.8 days; overall complication rate was 16.5%. Complications were most commonly cardiac, neurologic, or urinary (all 2.2%). Whereas preoperative to postoperative changes in ODI did not correlate with LOS, changes in PROMIS pain intensity ( = 0.167, = .024) and physical function ( = -0.169, = .023) did. Complications did not correlate with changes in ODI or PROMIS score; however, postoperative scores for physical function ( = -0.205, = .005) and pain interference ( = 0.182, = .014) both showed stronger correlations with complication occurrence than ODI ( = 0.143, = .055). Regression analysis showed postoperative physical function ( = 0.037, = .005) and pain interference ( = 0.028, = .014) could predict complications; ODI could not.
CONCLUSIONS
PROMIS domains of physical function and pain interference better reflected perioperative complications and LOS than the ODI. These results suggest PROMIS may offer more utility as an outcomes assessment instrument.
LEVEL OF EVIDENCE
背景
患者报告结局测量信息系统（PROMIS）与诸如奥斯威斯利功能障碍指数（ODI）等传统结局指标在反映胸腰椎手术人群围手术期并发症及住院时间（LOS）影响方面的敏感性尚未得到比较。本研究旨在评估PROMIS和ODI评分与胸腰椎手术患者的住院时间及并发症结局之间的关联强度。
方法
回顾性队列研究。纳入标准：年龄≥18岁且接受胸腰椎手术，术前及术后3个月有可用的ODI和PROMIS评分的患者。Pearson相关性分析评估住院时间、并发症与PROMIS（身体功能、疼痛强度、疼痛干扰）及ODI评分之间的线性关系。线性回归分析预测并发症发生率与ODI和PROMIS评分之间的关系。
结果
纳入182例接受胸腰椎手术的患者。常见诊断为椎管狭窄（62.1%）、神经根病（48.9%）和椎间盘突出（47.8%）。总体而言，58.3%的患者接受了融合手术，50.0%的患者接受了椎板切除术。患者的ODI（从50.2降至39.0）、PROMIS身体功能（从10.9提高到21.4）、疼痛强度（从92.4降至78.3）和疼痛干扰（从58.4降至49.8，均P <.001）在术前至术后均有改善。平均住院时间为2.7±2.8天；总体并发症发生率为16.5%。并发症最常见于心脏、神经或泌尿系统（均为2.2%）。虽然ODI术前至术后的变化与住院时间无相关性，但PROMIS疼痛强度（r = 0.167，P =.024）和身体功能（r = -0.169，P =.023）的变化与住院时间相关。并发症与ODI或PROMIS评分的变化无相关性；然而，术后身体功能评分（r = -0.205，P =.005）和疼痛干扰评分（r = 0.182，P =.014）与并发症发生的相关性均强于ODI（r = 0.143，P =.055）。回归分析显示术后身体功能（β = 0.037，P =.005）和疼痛干扰（β = 0.028，P =.014）可预测并发症；ODI则不能。
结论
与ODI相比, PROMIS身体功能和疼痛干扰领域能更好地反映围手术期并发症及住院时间。这些结果表明，PROMIS作为一种结局评估工具可能更具实用性。
证据级别
3级
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