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- Title
Assessing the Influence of Diabetes and Cardiopulmonary Disease on Patient Reported Outcomes: Pre- And Post-Operatively.
- Authors
Bunzel, Eli; Brodke, Darrel S.; Neese, Ashley; Yue Zhang; Reese, Jared C.; Spina, Nicholas
- Abstract
Introduction: Adult Spinal Deformity (ASD) negatively impacts quality of life, yet the surgical correction of ASD has been associated with major complication rates as high as 30-50%1; the magnitude of these procedures and complication rates highlight the importance of shared decision making and managed expectations between patient and physician. To adequately inform patients, we must understand how certain pre-operative factors influence disease presentation and post-operative outcomes. Recently, PROMIS Physical Function (PF) Computer Adaptive Testing (CAT) has gained popularity in measuring the health state of a patient's physical function2. PROMIS PF CAT has been shown to outperform the Oswestry Disability Index (ODI), a spine specific legacy patient reported outcome measure (PROM), in patients with lumbar spine pathology. Yet little is known about how PF CAT will change with surgical intervention or with various comorbidities3. This study aims to assess the effect of ASD surgical correction on PF CAT scores as well as the influence of diabetes and cardiopulmonary comorbidities on these PROMs. Materials and Methods: A retrospective review of all patients undergoing surgical correction of ASD from 2013-Present was performed to identify those who underwent fusion of at least 4 levels or greater. Patients with a primary diagnosis of tumor, infection, or trauma were excluded. PF CAT scores were obtained pre-operatively and post-operatively at 3, 6 and 12-month time periods. Patients with Diabetes Mellitus type 1 and 2, Heart Disease (history of MI, percutaneous coronary intervention for CHF, previous coronary artery bypass grafting), and COPD were identified based on ICD-9 and 10 documentation within the patient medical record. Linear Mixed Effect Models were performed to compare outcome scores in four cohorts: healthy cohort, diabetes mellitus, COPD and heart disease. These models were adjusted for age, gender, and BMI. Results: 180 patients met our inclusion criteria. The mean age was 66.8; 79 (44%) were male and 101 (56%) were female. Patients who reported no COPD (healthy) improved 6 points from their pre-operative PF CAT score (43.6) at 12 months post-op, while COPD patients (n = 10) decreased by 1.7 points at 12 months (p = .400) from their pre-operative PF CAT score (41.1). Conversely, ODI improved in both healthy and COPD cohorts by 12 months (p = .726). At 3 months, patients with Heart Disease (n = 37) saw a decrease in pre-operative PF CAT (37.6) of 0.8, but an overall improvement at 12 months similar to the healthy cohort (p = 0.433). ODI for Heart Disease patients improved steadily through 12 months, with a slower rate compared to the healthy cohort (p = 0.395). PF CAT and ODI scores for Diabetes Mellitus patients (n = 51) improved at a similar rate to the healthy cohort, but with a slower improvement in PF CAT from 6 to 12 months (p = 0.490). Statistical significance was not achieved. Conclusions: There appears to be a trend towards an impact of medical comorbidities on PF CAT scores, unlike the ODI. This seems to suggest that PF CAT is more sensitive to the effects of these disease states on their physical function domain compared to ODI.
- Publication
Global Spine Journal, 2018, Vol 8, p20S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030