Assessing the differences in characteristics of patients lost to follow-up at 2 years: results from the Quality Outcomes Database study on outcomes of surgery for grade I spondylolisthesis

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OBJECTIVE

Loss to follow-up has been shown to bias outcomes assessment among studies utilizing clinical registries. Here, the authors analyzed patients enrolled in a national surgical registry and compared the baseline characteristics of patients captured with those lost to follow-up at 2 years.

METHODS

The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes (PROs) among patients with grade I spondylolisthesis were evaluated.

RESULTS

Of the 608 patients enrolled in the study undergoing 1- or 2-level decompression (23.0%, n = 140) or 1-level fusion (77.0%, n = 468), 14.5% (n = 88) were lost to follow-up at 2 years. Patients who were lost to follow-up were more likely to be younger (59.6 ± 13.5 vs 62.6 ± 11.7 years, p = 0.031), be employed (unemployment rate: 53.3% [n = 277] for successful follow-up vs 40.9% [n = 36] for those lost to follow-up, p = 0.017), have anxiety (26.1% [n = 23] vs 16.3% [n = 85], p = 0.026), have higher back pain scores (7.4 ± 2.9 vs 6.6 ± 2.8, p = 0.010), have higher leg pain scores (7.4 ± 2.5 vs 6.4 ± 2.9, p = 0.003), have higher Oswestry Disability Index scores (50.8 ± 18.7 vs 46 ± 16.8, p = 0.018), and have lower EQ-5D scores (0.481 ± 0.2 vs 0.547 ± 0.2, p = 0.012) at baseline.

CONCLUSIONS

To execute future, high-quality studies, it is important to identify patients undergoing surgery for spondylolisthesis who might be lost to follow-up. In a large, prospective registry, the authors found that those lost to follow-up were more likely to be younger, be employed, have anxiety disorder, and have worse PRO scores.

ABBREVIATIONS ASA = American Society of Anesthesiologists; NASS = North American Spine Society; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database.
Article Information

Contributor Notes

Correspondence Mohamad Bydon: Mayo Clinic, Rochester, MN. bydon.mohamad@mayo.edu.INCLUDE WHEN CITING Published online February 28, 2020; DOI: 10.3171/2019.12.SPINE191155.Disclosures Dr. Bisson: consultant for nView, MiRus, and Stryker. Dr. Mummaneni: consultant for Globus, DePuy Synthes, and Stryker; direct stock ownership in Spinicity/ISD; clinical or research support for this study from NREF; support of non–study-related clinical or research effort from ISSG; honoraria from Spineart; and royalties from DePuy Synthes, Thieme Publishers, and Springer Publishers. Dr. Knightly: NPA board member. Dr. Chan: support of non–study-related clinical or research effort from Orthofix. Dr. Glassman: employee of Norton Healthcare; consultant for K2M and Medtronic; patent holder with Medtronic; clinical or research support for this study from NuVasive; royalties from Medtronic; chair of the American Spine Registry; and past president of the Scoliosis Research Society. Dr. Foley: consultant for Medtronic; direct stock ownership in Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, Medtronic, NuVasive, nView Medical, Practical Navigation/Fusion Robotics, SpineWave, TDi, and Triad Life Sciences; patent holder with Medtronic and NuVasive; board of directors of Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, nView Medical, Practical Navigation/Fusion Robotics, TDi, and Triad Life Sciences; and royalties from Medtronic. Dr. Potts: consultant for and patent holder with Medtronic. Dr. C. Shaffrey: consultant for NuVasive, Medtronic, and SI Bone; direct stock ownership in NuVasive; patent holder with NuVasive, Medtronic, and Zimmer Biomet. Dr. Haid: royalties from Globus Medical, Medtronic, and NuVasive; and shareholder in Globus Medical, NuVasive, Paradigm Spine, SpineWave, and Vertical Health (SpineUniverse). Dr. Fu: consultant for SI Bone, Globus, and Johnson & Johnson. Dr. Wang: consultant for DePuy Synthes Spine and Stryker; patent holder with DePuy Synthes Spine; ownership in Spineology; and direct stock ownership in ISD and Medical Device Partners. Dr. Park: consultant for Globus and NuVasive; royalties from Globus; and support of non–study-related clinical or research effort from DePuy.
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