PROMIS Physical Function for prediction of postoperative pain, narcotics consumption, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion

Restricted access

OBJECTIVE

This study aimed to determine if the preoperative Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF) score is predictive of immediate postoperative patient pain and narcotics consumption or long-term patient-reported outcomes (PROs) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

METHODS

A prospectively maintained database was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology were identified and grouped by their preoperative PROMIS PF scores: mild disability (score 40–50), moderate disability (score 30–39.9), and severe disability (score 20–29.9). Postoperative pain was quantified using the visual analog scale (VAS), and narcotics consumption was quantified using Oral Morphine Equivalents. PROMIS PF, Oswestry Disability Index (ODI), 12-Item Short-Form Health Survey, Physical Component Summary (SF-12 PCS), and VAS back and leg pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Preoperative PROMIS PF subgroups were tested for an association with demographic and perioperative characteristics using 1-way ANOVA or chi-square analysis. Preoperative PROMIS PF subgroups were tested for an association with immediate postoperative pain and narcotics consumption in addition to improvements in PROMIS PF, ODI, SF-12 PCS, and VAS back and leg pain by using linear regression controlling for statistically different demographic characteristics.

RESULTS

A total of 130 patients were included in this analysis. Patients were grouped by their preoperative PROMIS PF scores: 15.4% had mild disability, 63.8% had moderate disability, and 20.8% had severe disability. There were no significant differences among the subgroups in terms of age, sex, smoking status, and comorbidity burden. Patients with greater disability were more likely to be obese and to have workers’ compensation insurance. There were no differences among subgroups in regard to operative levels, operative time, estimated blood loss, and hospital length of stay. Patients with greater disability reported higher VAS pain scores and narcotics consumption for postoperative day 0 and postoperative day 1. Patients with greater preoperative disability demonstrated lower PROMIS PF, ODI, SF-12 PCS, and worse VAS pain scores at each postoperative time point.

CONCLUSIONS

Patients with worse preoperative disability, as assessed by PROMIS PF, experienced increased pain and narcotics consumption, along with less improvement in long-term PROs. The authors conclude that PROMIS PF is an efficient and accurate instrument that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.

ABBREVIATIONS BMI = body mass index; CCI = Charlson Comorbidity Index; LOS = length of hospital stay; MIS TLIF = minimally invasive transforaminal lumbar interbody fusion; ODI = Oswestry Disability Index; OME = Oral Morphine Equivalent; POD = postoperative day; PRO = patient-reported outcome; PROMIS PF = Patient-Reported Outcomes Measurement Information System, Physical Function; SF-12 PCS = 12-Item Short-Form Health Survey, Physical Component Summary; VAS = visual analog scale.

Article Information

Correspondence Kern Singh: Rush University Medical Center, Chicago, IL. kern.singh@rushortho.com.

INCLUDE WHEN CITING Published online February 1, 2019; DOI: 10.3171/2018.9.SPINE18863.

Disclosures Dr. Singh is a consultant for Zimmer Biomet and K2M. He is a member of the board of directors for Vital 5 LLC, TDi LLC, and the Minimally Invasive Spine Study Group. He is on the editorial board for Contemporary Spine Surgery, Orthopedics Today, and Vertebral Columns. He receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. He receives grants from the Cervical Spine Research Society.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Line graphs demonstrating improvements in PROs by disability subgroups, as defined by preoperative PROMIS PF scores. Figure is available in color online only.

References

  • 1

    Anderson MRHouck JRSaltzman CLHung MNickisch FBarg A: Validation and generalizability of preoperative PROMIS scores to predict postoperative success in foot and ankle patients. Foot Ankle Int 39:7637702018

  • 2

    Bobbitt KLKeplinger LMAlthari HK: Understanding addiction: the orthopedic surgical perspective to a significant problem. Clin Podiatr Med Surg 25:493515 viii2008

  • 3

    Brodke DJSaltzman CLBrodke DS: PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg 24:7447492016

  • 4

    Brodke DSGoz VVoss MWLawrence BDSpiker WRHung M: PROMIS PF CAT outperforms the ODI and SF-36 Physical Function Domain in spine patients. Spine (Phila Pa 1976) 42:9219292017

  • 5

    Crawford CH IIIGlassman SDDjurasovic MOwens RK IIGum JLCarreon LY: Prognostic factors associated with best outcomes (minimal symptom state) following fusion for lumbar degenerative conditions. Spine J [epub ahead of print] 2018

  • 6

    Department of Health and Human Services: Patient-Reported Outcomes Measurement Information System. Physical Function. (http://www.healthmeasures.net/administrator/components/com_instruments/uploads/PROMIS%20Physical%20Function%20Scoring%20Manual.pdf) [Accessed December 28 2018]

  • 7

    Fairbank JCPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000

  • 8

    Hey HWDLuo NChin SYLau ETCWang PKumar N: The predictive value of preoperative health-related quality-of-life scores on postoperative patient-reported outcome scores in lumbar spine surgery. Global Spine J 8:1561632018

  • 9

    Ho BHouck JRFlemister ASKetz JOh IDiGiovanni BF: Preoperative PROMIS scores predict postoperative success in foot and ankle patients. Foot Ankle Int 37:9119182016

  • 10

    Hung MHon SDFranklin JDKendall RWLawrence BDNeese A: Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976) 39:1581632014

  • 11

    Joeris AKnoll CKalampoki VBlumenthal AGaskell G: Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons. BMJ Open 8:e0206292018

  • 12

    Kanaan SFArnold PMBurton DCYeh HWLoyd LSharma NK: Investigating and predicting early lumbar spine surgery outcomes. J Allied Health 44:83902015

  • 13

    Kee JRSmith RGBarnes CL: Recognizing and reducing the risk of opioid misuse in orthopaedic practice. J Surg Orthop Adv 25:2382432016

  • 14

    Kim HJLee JIKang KTChang BSLee CKRuscheweyh R: Influence of pain sensitivity on surgical outcomes after lumbar spine surgery in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 40:1932002015

  • 15

    Kim HJPark JHKim JWKang KTChang BSLee CK: Prediction of postoperative pain intensity after lumbar spinal surgery using pain sensitivity and preoperative back pain severity. Pain Med 15:203720452014

  • 16

    Koerner JDGlaser JRadcliff K: Which variables are associated with patient-reported outcomes after discectomy? Review of SPORT disc herniation studies. Clin Orthop Relat Res 473:200020062015

  • 17

    Lall MPRestrepo E: Predictors of weeks to opioid cessation after lumbar fusion: a prospective cohort study. Pain Manag Nurs 19:5255342018

  • 18

    McGirt MJBydon MArcher KRDevin CJChotai SParker SL: An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making. J Neurosurg Spine 27:3573692017

  • 19

    Papuga MOBarnes AL: Correlation of PROMIS CAT instruments with Oswestry Disability Index in chiropractic patients. Complement Ther Clin Pract 31:85902018

  • 20

    Papuga MOMesfin AMolinari RRubery PT: Correlation of PROMIS Physical Function and Pain CAT instruments with Oswestry Disability Index and Neck Disability Index in spine patients. Spine (Phila Pa 1976) 41:115311592016

  • 21

    Patel AADodwad SMBoody BSBhatt SSavage JWHsu WK: Validation of Patient Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Tests (CATs) in the surgical treatment of lumbar spinal stenosis. Spine (Phila Pa 1976) 43:152115282018

  • 22

    Purvis TEAndreou ENeuman BJRiley LH IIISkolasky RL: Concurrent validity and responsiveness of PROMIS health domains among patients presenting for anterior cervical spine surgery. Spine (Phila Pa 1976) 42:E1357E13652017

  • 23

    Purvis TENeuman BJRiley LH IIISkolasky RL: Discriminant ability, concurrent validity, and responsiveness of PROMIS health domains among patients with lumbar degenerative disease undergoing decompression with or without arthrodesis. Spine (Phila Pa 1976) 43:151215202018

  • 24

    Sabatino MJKunkel STRamkumar DBKeeney BJJevsevar DS: Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am 100:1801882018

  • 25

    Sielatycki JAChotai SStonko DWick JKay HMcGirt MJ: Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions? Eur Spine J 25:162716332016

  • 26

    Skolasky RLWegener STMaggard AMRiley LH III: The impact of reduction of pain after lumbar spine surgery: the relationship between changes in pain and physical function and disability. Spine (Phila Pa 1976) 39:142614322014

  • 27

    Ware J JrKosinski MKeller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:2202331996

  • 28

    Williamson AHoggart B: Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:7988042005

  • 29

    Wong SEZhang ALBerliner JLMa CBFeeley BT: Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 25:9139192016

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 61 61 61
Full Text Views 17 17 17
PDF Downloads 28 28 28
EPUB Downloads 0 0 0

PubMed

Google Scholar