Teo Bryon Jun Xiong, Howe Tet Sen, Chan Cheri, Koh Joyce Sb, Yeo William, Ng Yeong Huei
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Orthopaedic Diagnostic Centre, Singapore General Hospital, Singapore.
Geriatr Orthop Surg Rehabil. 2023 Jan 15;14:21514593231152172. doi: 10.1177/21514593231152172. eCollection 2023.
INTRODUCTION: The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery. AIMS: To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction. METHODS: 1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score. RESULTS: At 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 ( < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups. CONCLUSIONS: Overall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients' satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.
引言:患者报告结局在术前评估中的作用尚未得到充分研究。最近人们对研究患者报告结局评分是否可单独使用,或与临床检查结果相结合,用于手术患者评估产生了兴趣。 目的:探讨在1-2节段经椎间孔腰椎椎体间融合术(TLIF)中,具有临床意义的评分改善是否与术后患者满意度相关。我们还旨在确定一个与实现术后最小临床重要差异(MCID)和患者满意度相关的Oswestry功能障碍指数(ODI)阈值。 方法:本研究纳入了在我们机构接受单节段或双节段TLIF(微创和开放手术)且至少随访2年的1001例患者。我们研究了自我报告的指标,包括患者满意度和ODI评分。 结果:在2年随访时,总体平均ODI评分从49.7±18.3改善至13.9±15.2(P<0.001),74.6%的患者达到MCID。所有患者中有95.3%实现了患者满意度。在微创组中,与曲线下面积(AUC)为0.72(95%可信区间0.65-0.86)相关的最大约登指数处,术前截断值确定为37.2。在开放组中,与AUC为0.70(95%可信区间0.62-0.77)相关的最大约登指数处,术前截断值确定为37.2。使用所发现的术前截断值,微创组和开放组的患者满意度无显著差异。 结论:总体而言,接受TLIF手术的患者术后2年ODI评分改善良好且患者满意度较高。虽然达到ODI评分的MCID与患者术后满意度相关,但75%未达到ODI评分MCID的患者对手术仍感到满意。我们无法确定一个与实现术后MCID和患者满意度相关的术前ODI阈值。
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