The use of patient-reported preoperative activity levels as a stratification tool for short-term and long-term outcomes in patients with adult spinal deformity

Restricted access

OBJECTIVE

Given the recent shift in health care toward quality reporting requirements and a greater emphasis on a cost-quality approach, patient stratification with respect to long-term outcomes and the use of health care resources is of increasing value. Stratification tools may be effective if they are simple and evidence based. The authors hypothesize that preoperative patient-reported activity levels might independently predict postoperative outcomes in patients with adult spinal deformity.

METHODS

This is a retrospective cohort. A total of 575 patients in a prospective adult spinal deformity surgical database were identified with complete data regarding the preoperative level of activity. Answers to question 5 of the Scoliosis Research Society-22r Patient Questionnaire (SRS-22r) were used to stratify patients into active and inactive groups. Outcomes were length of hospital stay (LOS), level of activity, and reaching the minimum clinically important difference (MCID) for SRS-22r domains and the Physical Component Summary (PCS) of the SF-36 at 2 years postoperatively. The 2 groups were compared with respect to several potential confounders. Covariates with p < 0.1 were controlled for. The impact of activity on LOS was assessed using multivariate negative binomial regression analysis. Multivariate logistic regression models additionally controlling for the respective baseline health-related quality of life (HRQOL) scores were used to assess the association between preoperative activity levels and reaching the MCID at 2 years postoperatively.

RESULTS

A total of 420 (73%) of the 575 patients who met the inclusion criteria had complete data at 2 years postoperatively. The inactive group was more likely to be significantly older, have a higher Charlson Comorbidity Index, worse baseline radiographic deformity, and greater correction of most radiographic parameters. After controlling for possible confounders, the active group had a significantly shorter LOS (incidence risk ratio 0.91, p = 0.043). After adding respective baseline HRQOL scores to the models, active patients were significantly more likely to reach the MCID for the SRS-22r pain domain (OR 1.72, p = 0.026) and PCS (OR 1.94, p = 0.013). Active patients were also significantly more likely to be active at 2 years postoperatively on multivariate analysis (OR 8.94, p < 0.001).

CONCLUSIONS

The authors’ results show that patients who belong to the inactive group are likely to have a longer LOS and lower odds of reaching the MCID in HRQOL or being active at 2 years postoperatively. Inquiring about patients’ preoperative activity levels might be a reliable and simple stratification tool in terms of long- and short-term outcomes in ASD patients.

ABBREVIATIONS ASD = adult spinal deformity; CCI = Charlson Comorbidity Index; HRQOL = health-related quality of life; IRR = incidence risk ratio; LL = lumbar lordosis; LOS = length of stay; MCID = minimum clinically important difference; PCS = Physical Component Summary; PI = pelvic incidence; PT = pelvic tilt; SRS-22r = Scoliosis Research Society-22r Patient Questionnaire; SVA = sagittal vertical axis.

Article Information

Correspondence Daniel M. Sciubba: The Johns Hopkins University, Baltimore, MD. dsciubb1@jhmi.edu.

INCLUDE WHEN CITING Published online April 6, 2018; DOI: 10.3171/2017.10.SPINE17830.

Disclosures The ISSG is funded by payments from DePuy Synthes Spine, K2M, NuVasive, Biomet, and Orthofix.

Dr. Neuman: support of non–study-related clinical or research effort from DePuy Synthes. Dr. Hassanzadeh: consultant for NuVasive, and clinical or research support for this study from Pfizer and Orthofix. Dr. Passias: consultant for Medicrea and SpineWave, support of non–study-related clinical or research effort from DSRS, and speaking/teaching arrangements with Zimmer Biomet. Dr. Klineberg: consultant for DePuy, Stryker, Trevena, and Springer; honoraria from K2M and AO Spine; and AO Spine fellowship grant. Dr. Mundis: consultant for NuVasive, K2M, and Allosource; patent holder with NuVasive and K2M; and nonfinancial relationships with SOLAS, GSO, and SDSF. Dr. Protopsaltis: consultant for Medicrea, NuVasive, Globus, and Innovasis; and support of non–study-related clinical or research effort from Zimmer Biomet and Cervical Spine Research Society. Dr. Smith: clinical or research support for this study from DePuy Synthes/ISSG; consultant for Zimmer Biomet, K2M, NuVasive, and Allosource; support of non–study-related clinical or research effort from DePuy Synthes/ISSG; royalties from Zimmer Biomet; and fellowship funding from NREF and AO Spine. Dr. Lafage: direct stock ownership in Nemaris Inc.; support of non–study-related clinical or research effort from DePuy Spine, NuVasive, K2M (paid through ISSG Foundation), SRS, and NASS; speaking/teaching arrangements with DePuy, AO Spine, and MSD; and consultant for NuVasive. Dr. Bess: consultant for K2M and Allosource; clinical or research support for this study from ISSG Foundation; and support of non–study-related clinical or research effort from DePuy Synthes, Medtronic, NuVasive, K2M, and Orthofix. Dr. Sciubba: consultant for DePuy Synthes, Medtronic, Stryker, NuVasive, and K2M.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Adogwa OElsamadicy AAFialkoff JCheng JKarikari IOBagley C: Early ambulation decreases length of hospital stay, peri-operative complications and improves functional outcomes in elderly patients undergoing surgery for correction of adult degenerative scoliosis. Spine (Phila Pa 1976) [epub ahead of print] 2017

2

Allison PD: Multiple Regression: A Primer. Thousand Oaks, CA: Pine Forge Press1999

3

Andrawis JAkhavan SChan VLehil MPong DBozic KJ: Higher preoperative patient activation associated with better patient-reported outcomes after total joint arthroplasty. Clin Orthop Relat Res 473:268826972015

4

Ashe MCMiller WCEng JJNoreau L: Older adults, chronic disease and leisure-time physical activity. Gerontology 55:64722009

5

Awdeh HKassak KSfeir PHatoum HBitar HHusari A: The SF-36 and 6-minute walk test are significant predictors of complications after major surgery. World J Surg 39:140614122015

6

Blondel BSchwab FUngar BSmith JBridwell KGlassman S: Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 71:3413482012

7

Daniele TMBruin VMOliveira DSPompeu CMForti AC: Associations among physical activity, comorbidities, depressive symptoms and health-related quality of life in type 2 diabetes. Arq Bras Endocrinol Metabol 57:44502013

8

de Arenaza DPPepper JLees BRubinstein FNugara FRoughton M: Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart 96:1131172010

9

De la Garza Ramos RGoodwin CRElder BDBoah AOMiller EKJain A: Preoperative functional status as a predictor of short-term outcome in adult spinal deformity surgery. J Clin Neurosci 39:1181232017

10

Evangelista LSCacciata MStromberg ADracup K: Dose-response relationship between exercise intensity, mood states, and quality of life in patients with heart failure. J Cardiovasc Nurs 32:5305372017

11

Fabricant PDAdmoni SGreen DWIpp LSWidmann RF: Return to athletic activity after posterior spinal fusion for adolescent idiopathic scoliosis: analysis of independent predictors. J Pediatr Orthop 32:2592652012

12

Glassman SDCopay AGBerven SHPolly DWSubach BRCarreon LY: Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 90:183918472008

13

Hayashi KHirashiki AKodama AKobayashi KYasukawa YShimizu M: Impact of preoperative regular physical activity on postoperative course after open abdominal aortic aneurysm surgery. Heart Vessels 31:5785832016

14

Hibbard JHGreene J: What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood) 32:2072142013

15

Kiebzak GMPierson LMCampbell MCook JW: Use of the SF36 general health status survey to document health-related quality of life in patients with coronary artery disease: effect of disease and response to coronary artery bypass graft surgery. Heart Lung 31:2072132002

16

Klineberg EOPassias PGJalai CMWorley NSciubba DMBurton DC: Predicting extended length of hospital stay in an adult spinal deformity surgical population. Spine (Phila Pa 1976) 41:E798E8052016

17

Martin BIDeyo RAMirza SKTurner JAComstock BAHollingworth W: Expenditures and health status among adults with back and neck problems. JAMA 299:6566642008

18

Meyer CHaumont TGauchard GCLeheup BLascombes PPerrin PP: The practice of physical and sporting activity in teenagers with idiopathic scoliosis is related to the curve type. Scand J Med Sci Sports 18:7517552008

19

Naugle KMFillingim RBRiley JL III: A meta-analytic review of the hypoalgesic effects of exercise. J Pain 13:113911502012

20

Nijs JKosek EVan Oosterwijck JMeeus M: Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician 15 (3 Suppl):ES205ES2132012

21

Ojagbemi AAkin-Ojagbemi N: Exercise and quality of life in dementia. J Appl Gerontol [epub ahead of print] 2017

22

Onerup ABock DBörjesson MFagevik Olsén MGellerstedt MHaglind E: Is preoperative physical activity related to post-surgery recovery?—a cohort study of colorectal cancer patients. Int J Colorectal Dis 31:113111402016

23

Pellisé FVila-Casademunt AFerrer MDomingo-Sàbat MBagó JPérez-Grueso FJ: Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3112015

24

Pouwels SHageman DGommans LNWilligendael EMNienhuijs SWScheltinga MR: Preoperative exercise therapy in surgical care: a scoping review. J Clin Anesth 33:4764902016

25

Sandoz JSRoberts MMCho JGWheatley JR: Magnitude of exercise capacity and quality of life improvement following repeat pulmonary rehabilitation in patients with COPD. Int J Chron Obstruct Pulmon Dis 12:108510912017

26

Schwab FPatel AUngar BFarcy JPLafage V: Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:222422312010

27

Schwab FJBlondel BBess SHostin RShaffrey CISmith JS: Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803E8122013

28

Silman AJO’Neill TWCooper CKanis JFelsenberg D: Influence of physical activity on vertebral deformity in men and women: results from the European Vertebral Osteoporosis Study. J Bone Miner Res 12:8138191997

29

Terran JMcHugh BJFischer CRLonner BWarren DGlassman S: Surgical treatment for adult spinal deformity: projected cost effectiveness at 5-year follow-up. Ochsner J 14:14222014

30

Tveit MRosengren BENilsson JAAhlborg HGKarlsson MK: Bone mass following physical activity in young years: a mean 39-year prospective controlled study in men. Osteoporos Int 24:138913972013

31

Tzeng ATzeng THVasdev SGrindy ASaleh JKSaleh KJ: The role of patient activation in achieving better outcomes and cost-effectiveness in patient care. JBJS Rev 3:e42015

32

U.S. Department of Health and Human Services: Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and policy changes and fiscal year 2017 rates; quality reporting requirements for specific providers; graduate medical education; hospital notification procedures applicable to beneficiaries receiving observation services; technical changes relating to costs to organizations and Medicare cost reports; finalization of interim final rules with comment period on LTCH PPS payments for severe wounds, modifications of limitations on redesignation by the Medicare geographic classification review board, and extensions of payments to MDHs and low-volume hospitals; final rule. Fed Regist 81:56761574382016

33

Yadla SGhobrial GMCampbell PGMaltenfort MGHarrop JSRatliff JK: Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate. J Neurosurg Spine 23:8078112015

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 86 86 15
Full Text Views 67 67 7
PDF Downloads 121 121 6
EPUB Downloads 0 0 0

PubMed

Google Scholar