Importance of achieving Scoliosis Research Society–22r minimal clinically important difference for improving patient satisfaction after adult spinal deformity surgery

Hideyuki Arima MD, PhD1, Tomohiko Hasegawa MD, PhD1, Yu Yamato MD, PhD1,2, Go Yoshida MD, PhD1, Tomohiro Banno MD, PhD1, Shin Oe MD, PhD1,2, Yuki Mihara MD, PhD1, Hiroki Ushirozako MD, PhD1, Tomohiro Yamada MD1, Yuh Watanabe MD1, Koichiro Ide MD1, Keiichi Nakai MD1, Kenta Kurosu MD1, and Yukihiro Matsuyama MD, PhD1
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  • 1 Department of Orthopaedic Surgery and
  • | 2 Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
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OBJECTIVE

Achievement of minimal clinically important differences (MCIDs) in the Scoliosis Research Society–22r (SRS-22r) subdomains represents surgical efficacy. However, whether achievements of MCIDs in SRS-22r domains are associated with long-term satisfaction in patients with adult spinal deformity (ASD) is unclear. This study aimed to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery in patients with ASD.

METHODS

Data obtained in 187 patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2017 and underwent follow-up for 2 years were retrospectively reviewed. The authors investigated the likelihood of achieving MCIDs in the function, pain, self-image, mental health, and subtotal domains 2 years after surgery. The following MCID values were used: function, 0.90; pain, 0.85; self-image, 1.05; mental health, 0.70; and subtotal, 1.05. Multivariate analysis was performed to evaluate factors associated with patient satisfaction 2 years after surgery.

RESULTS

The average satisfaction scores in the group that achieved MCID and the group that did not were as follows: 3.97 and 3.37 for function (p < 0.001), 3.66 and 3.51 for pain (p = 0.221), 3.84 and 3.06 for self-image (p < 0.001), 3.82 and 3.28 for mental health (p < 0.001), and 3.96 and 3.30 for subtotal (p < 0.001), respectively. Except for the pain domain, the group that achieved MCIDs showed greater satisfaction than the group that did not achieve MCIDs. On multivariate analysis, factors related to postoperative satisfaction were achievement of SRS-22r self-image (standardization coefficient 0.322, p < 0.001) and function (standardization coefficient 0.179, p = 0.026) MCIDs. Perioperative complications and revision surgery were not related to patient satisfaction.

CONCLUSIONS

Multivariate analysis demonstrated that achievement of MCIDs in SRS-22r self-image and function domains was significantly associated with postoperative satisfaction. Given that patients with poor preoperative health-related quality of life are more likely to achieve MCIDs in SRS-22r domains, surgeons should carefully consider whether to operate on patients with relatively good baseline health-related quality of life when making surgical decisions.

ABBREVIATIONS

ASD = adult spinal deformity; AUC = area under the curve; CCI = Charlson Comorbidity Index; HRQOL = health-related quality of life; HS = highly satisfied; LL = lumbar lordosis; LLIF = lateral lumbar interbody fusion; LS = less satisfied; MCID = minimal clinically important difference; PI = pelvic incidence; PI-LL = PI minus LL; PROM = patient-reported outcome measure; PT = pelvic tilt; ROC = receiver operating characteristic; SRS-22r = Scoliosis Research Society–22r; SVA = sagittal vertical axis; TK = thoracic kyphosis; UIV = upper instrumented vertebra.

Illustration from Rothrock et al. (pp 535–545). Copyright Roberto Suazo. Published with permission.

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