Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Jacobs School of Medicine And Biomedical Sciences, Buffalo, NY, United States.
J Neurooncol. 2024 May;167(3):477-485. doi: 10.1007/s11060-024-04627-0. Epub 2024 Mar 4.
Patient-reported outcome measures (PROMs) are increasingly used to assess patients' perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear.
To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients.
Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes.
A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5+10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020).
The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.
患者报告的结局测量（PROMs）越来越多地用于评估患者围手术期的健康状况。PROMIS-29 是一种经过充分验证的全球健康评估工具，用于评估患者的身体健康，但它在颅神经外科中的应用尚不清楚。
探讨术前 PROMIS-29 身体健康（PH）综合评分在预测脑肿瘤患者术后结局中的作用。
本研究为单中心前瞻性研究，纳入 2018 年 1 月至 2021 年 12 月期间在我院行手术治疗的脑肿瘤患者，在术前访视期间患者接受 PROMIS-29 问卷调查。构建 PH 综合评分，并通过寻找相关受试者工作特征曲线的约登指数来近似 LOS、DD 和 30 天再入院的最佳预测阈值。采用二变量分析研究根据基线特征，低（z 分数≤-1）与高（z 分数>-1）PH 评分的分布情况。Logistic 回归模型量化了术前 PH 综合评分与术后结局之间的关联。
共纳入 157 例脑肿瘤患者（平均年龄 55.4±15.4 岁；58.0%为女性；平均 PH 评分为 45.5+10.5）。研究结局包括 LOS 延长（24.8%）、非常规出院（37.6%）和 30 天再入院（19.1%）。在单变量分析中，低 PH 评分患者更有可能被诊断为高级别肿瘤（69.6%比 38.85%，p=0.010），不太可能接受择期手术（34.8%比 70.9%，p=0.002）。低 PH 评分与 LOS 延长（26.1%比 22%，p<0.001）、非常规出院（73.9%比 31.3%，p<0.001）和 30 天再入院（43.5%比 14.9%，p=0.003）有关。在多变量分析中，低 PH 评分预测 LOS 延长（比值比[OR]=6.09，p=0.003）、非常规出院（OR=4.25，p=0.020）和 30 天再入院（OR=3.93，p=0.020）的风险更高。
PROMIS-29 PH 综合评分可预测脑肿瘤患者的短期术后结局，并可纳入前瞻性临床工作流程。
