腰椎间盘显微切除术后患者报告结局测量信息系统身体功能与术后疼痛、麻醉药物消耗及患者报告结局指标之间的关联

Association Between Patient Reported Outcomes Measurement Information System Physical Function With Postoperative Pain, Narcotics Consumption, and Patient-Reported Outcome Measures Following Lumbar Microdiscectomy.

作者信息

Bovonratwet Patawut, Vaishnav Avani S, Mok Jung K, Urakawa Hikari, Dupont Marcel, Melissaridou Dimitra, Shahi Pratyush, Song Junho, Shinn Daniel J, Dalal Sidhant S, Araghi Kasra, Sheha Evan D, Gang Catherine H, Qureshi Sheeraz A

机构信息

Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA.

出版信息

Global Spine J. 2024 Jan;14(1):225-234. doi: 10.1177/21925682221103497. Epub 2022 May 27.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To determine association between preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores with postoperative pain, narcotics consumption, and patient-reported outcome measures (PROMs) following single-level lumbar microdiscectomy.

METHODS

Consecutive patients who underwent single-level lumbar microdiscectomy were identified from May 2017-May 2020. Patients were grouped by their preoperative PROMIS-PF scores: mild disability (score≥40), moderate disability (score 30-39.9), and severe disability (score<30). Preoperative PROMIS-PF subgroups were tested for association with inpatient postoperative pain, total inpatient narcotics consumption, time to narcotic use cessation as well as improvements in postoperative PROMIS-PF, ODI, VAS-Leg Pain, VAS-Back Pain, SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS) at 2-, 6-, 12-weeks, 6-month, 1-year, 2-year follow-up.

RESULTS

A total of 127 patients were included. Patients with greater disability reported higher inpatient maximum Visual Analog Scale (VAS) pain scores ( = .023) and total inpatient narcotics consumption ( = .008) but no difference in time to narcotic cessation after surgery ( = .373). However, patients with greater preoperative disability also demonstrated greater improvement from baseline in PROMIS-PF, ODI, SF-12 PCS, and SF-12 MCS at 2-week follow-up ( < .05). These higher improvements from baseline for patients with greater preoperative disability were sustained for PROMIS-PF, ODI, and VAS-Leg Pain at 2-year follow-up ( < .05).

CONCLUSIONS

Patients with greater preoperative disability, as measured by PROMIS-PF, had increased inpatient postoperative pain and narcotics consumption, but also higher improvement from baseline in long-term PROMs. This data can be utilized for patient counseling and setting expectations.

研究设计

回顾性队列研究。

目的

确定单节段腰椎间盘显微切除术患者术前患者报告结局测量信息系统身体功能（PROMIS-PF）评分与术后疼痛、麻醉药品用量以及患者报告结局指标（PROMs）之间的关联。

方法

从2017年5月至2020年5月连续入选接受单节段腰椎间盘显微切除术的患者。根据术前PROMIS-PF评分对患者进行分组：轻度残疾（评分≥40）、中度残疾（评分30-39.9）和重度残疾（评分<30）。对术前PROMIS-PF亚组进行测试，以确定其与术后住院疼痛、住院期间麻醉药品总用量、停止使用麻醉药品的时间以及术后2周、6周、12周、6个月、1年、2年随访时PROMIS-PF、ODI、腿部视觉模拟评分（VAS-Leg Pain）、背部视觉模拟评分（VAS-Back Pain）、SF-12身体成分评分（PCS）、SF-12精神成分评分（MCS）改善情况之间的关联。

结果

共纳入127例患者。残疾程度较重的患者术后住院期间最大视觉模拟评分（VAS）疼痛评分较高（P = 0.023），住院期间麻醉药品总用量较多（P = 0.008），但术后停止使用麻醉药品的时间无差异（P = 0.373）。然而，术前残疾程度较重的患者在术后2周时PROMIS-PF、ODI、SF-12 PCS和SF-12 MCS较基线水平的改善也更大（P<0.05）。术前残疾程度较重的患者在术后2年随访时，PROMIS-PF、ODI和VAS-Leg Pain较基线水平的更高改善情况得以持续（P<0.05）。