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- Title
Physical Function Outcomes In Patients With Cardiopulmonary Disease Undergoing Lumbar Spinal Fusion.
- Authors
Reese, Jared C.; Brodke, Darrel S.; Neese, Ashley; Yue Zhang; Bunzel, Eli; Squires, Mathieu D.; Spina, Nicholas
- Abstract
Introduction: The PROMIS® Physical Function (PF) Computerized Adaptive Test (CAT) is an electronic questionnaire used to measure a patient's physical function[1]. Responses provide meaningful data for physicians to assess a patient's physical competency before and after orthopaedic surgery, and has been validated in the spine population[2, 3, 4]. However, the responsiveness of PF CAT scores to specific interventions within the lumbar spine and the effects of medical comorbidities on these scores have yet to be investigated. The purpose of this study is to evaluate the responsiveness of PROMIS PF CAT in single and two level lumbar fusions as well as the effects of cardiopulmonary comorbidities on these outcomes. Materials and Methods: A retrospective chart review was performed to identify patients who underwent a single or two level lumbar spine fusion between October 1, 2013 to June 1, 2017 at a single spine clinic. Patients were included if PF CAT and Oswestry Disability Index (ODI) questionnaires were completed at both pre- and post-operative time points. Patients were then stratified into two cohorts (either cardiac or pulmonary) based on ICD-9 and ICD-10 codes identified within patient records - such as CHF, arrhythmias, MI, emphysema, PE, and COPD. An adjusted linear regression model with mixed-effects was constructed to analyze PF CAT and ODI scores at preoperative, 3, 6, and 12 month time points. Results: Of the 972 patients identified (mean age 61, 48% male), 71 had a cardiac comorbidity and 79 had a pulmonary comorbidity. When adjusted for age, gender, and BMI, cardiac patients PF CAT scores ranked lower than non-cardiac patients at the preoperative, 3, 6, and 12 month time points (Cardiac: 42.9, 44.6, 44.9, 45.3; Non-Cardiac: 43.1, 45.5, 47,9, 47.8), with a significant difference found at the 6 month (p = 0.016) and 12 month (p = 0.003) time points. Cardiac patients ODI scores ranked higher than non-cardiac patients at all time points (Cardiac: 34.7, 31.9, 30.4, 23.0; Non-Cardiac: 31.9, 20.6, 15.5, 16.7), with a significant difference at the 3 month (p = 0.026) and 6 month (p = 0.021) time points. Pulmonary patients PF CAT scores ranked lower than non-pulmonary patients across all time points (Pulmonary: 41.0, 42.4, 41.5, 41.5; Non-pulmonary: 43.2, 45.7, 48.2, 48.1), with a significant difference found at the preoperative (p = 0.012), 6 month (p = 0.002), and 12 month (p < 0.001) time points. Pulmonary patients ODI scores ranked higher than non-pulmonary patients at all time points (Pulmonary: 37.0, 35.9, 31.5, 27.3; Non-pulmonary: 33.0, 21.7, 16.7, 17.8), with a significant difference found at the 3 month (p < 0.001), 6 month (p < 0.001), and 12 month (p = 0.014) time points. Conclusion: This study demonstrates a treatment response curve of physical function for lumbar spinal fusion over a one year period of time. In this cohort, cardiopulmonary patients improved less than the control group based on PF CAT and ODI metrics. Theses results suggest that the decreased responsiveness of improved physical function may likely be due to an individuals comorbidity. For these patient populations, adjusting treatment expectations based on PROMIS or assessing different outcomes, such as leg and back pain, may improve the evaluation of treatment efficacy.
- Publication
Global Spine Journal, 2018, Vol 8, p250S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771072