Nie James W, Hartman Timothy J, Oyetayo Omolabake O, MacGregor Keith R, Zheng Eileen, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2023 Jan;169:e270-e278. doi: 10.1016/j.wneu.2022.10.122. Epub 2022 Nov 9.
Newer Patient-Reported Outcomes (PROs) may offer benefits over legacy PROs in ease of administration and interpretation. We aim to study the influence of preoperative pain interference (PI) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) on postoperative clinical outcomes in patients undergoing lumbar decompression.
Patients undergoing lumbar decompression without fusion were separated into 2 cohorts: PROMIS-PI < 64 (lesser PI) and PROMIS-PI ≥ 64 (greater PI). PROs included PROMIS physical function, PROMIS anxiety (PROMIS-A), PROMIS sleep disturbance (PROMIS-SD), PROMIS-PI, Patient Health Questionnaire-9, Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) and were collected at preoperative and postoperative time points. Demographics, perioperative characteristics, PROs, and Minimum Clinically Important Difference (MCID) were compared among groups through non-parametric inferential statistics.
One-hundred and seven patients were identified. Independent of preoperative PI, patients reported significant postoperative improvement in PROMIS physical function, PROMIS-A, PROMIS-PI, VAS back, VAS leg, and ODI. The greater PI cohort reported significant postoperative improvement in Patient Health Questionnaire-9 and PROMIS-SD. The lesser PI cohort reported superior preoperative PROs in all domains. Postoperatively, the lesser PI cohort reported superior 6-week PROMIS-A and PROMIS-SD. MCID achievement rates were higher in the greater PI cohort for PROMIS-PI, VAS back, VAS leg, and ODI.
Patients with lower preoperative PI reported superior postoperative anxiety and sleep disturbance. Patients with greater preoperative PI had higher MCID achievement rates in PI, pain, and disability. Patients with greater preoperative PI undergoing lumbar decompression may demonstrate higher rates of clinically tangible improvement.
较新的患者报告结局（PROs）在管理和解释的便利性方面可能优于传统的PROs。我们旨在研究使用患者报告结局测量信息系统（PROMIS）疼痛干扰量表（PROMIS-PI）评估的术前疼痛干扰（PI）对接受腰椎减压手术患者术后临床结局的影响。
接受非融合腰椎减压手术的患者被分为两个队列：PROMIS-PI < 64（较低PI）和PROMIS-PI≥64（较高PI）。PROs包括PROMIS身体功能、PROMIS焦虑量表（PROMIS-A）、PROMIS睡眠障碍量表（PROMIS-SD）、PROMIS-PI、患者健康问卷-9、视觉模拟量表（VAS）背部、VAS腿部以及奥斯维斯特残疾指数（ODI），并在术前和术后时间点收集。通过非参数推断统计比较各组之间的人口统计学、围手术期特征、PROs和最小临床重要差异（MCID）。
共纳入107例患者。无论术前PI如何，患者报告术后PROMIS身体功能、PROMIS-A、PROMIS-PI、VAS背部、VAS腿部和ODI均有显著改善。较高PI队列报告术后患者健康问卷-9和PROMIS-SD有显著改善。较低PI队列在所有领域的术前PROs均表现更佳。术后，较低PI队列在6周时的PROMIS-A和PROMIS-SD表现更佳。在PROMIS-PI、VAS背部、VAS腿部和ODI方面，较高PI队列的MCID达成率更高。
术前PI较低的患者术后焦虑和睡眠障碍较轻。术前PI较高的患者在PI、疼痛和残疾方面的MCID达成率更高。接受腰椎减压手术且术前PI较高的患者可能显示出更高的临床显著改善率。
