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首页> 外文期刊>Neurosurgical focus >Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?
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Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?

机译：脊椎外科患者3个月的患者报告的结果：是在现实世界登记平台中为12个月结果的准确预测因素吗？

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OBJECT The health care landscape is rapidly shifting to incentivize quality of care rather than quantity of care. Quality and outcomes registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in health care delivery. Obtaining real-world registry outcomes data from patients 12 months after spine surgery remains a challenge. The authors set out to determine whether 3-month patient-reported outcomes accurately predict 12-month outcomes and, hence, whether 3-month measurement systems suffice to identify effective versus noneffective spine care. METHODS All patients undergoing lumbar spine surgery for degenerative disease at a single medical institution over a 2-year period were enrolled in a prospective longitudinal registry. Patient-reported outcome instruments (numeric rating scale [NRS], Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12], EQ-5D, and the Zung SelfRating Depression Scale) were recorded prospectively at baseline and at 3 months and 12 months after surgery. Linear regression was performed to determine the independent association of 3- and 12-month outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine whether improvement in general health state (EQ-5D) and disability (ODI) at 3 months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months. RESULTS A total of 593 patients undergoing elective lumbar surgery were included in the study. There was a significant correlation between 3-month and 12-month EQ-5D (r = 0.71; p < 0.0001) and ODI (r = 0.70; p < 0.0001); however, the authors observed a sizable discrepancy in achievement of a clinically significant improvement (MCID) threshold at 3 versus 12 months on an individual patient level. For postoperative disability (ODI), 11.5% of patients who achieved an MCID threshold at 3 months dropped below this threshold at 12 months; 10.5% of patients who did not meet the MCID threshold at 3 months continued to improve and ultimately surpassed the MCID threshold at 12 months. For ODI, achieving MCID at 3 months accurately predicted 12-month MCID with only 62.6% specificity and 86.8% sensitivity. For postoperative health utility (EQ-5D), 8.5% of patients lost an MCID threshold improvement from 3 months to 12 months, while 4.0% gained the MCID threshold between 3 and 12 months postoperatively. For EQ-5D (quality-adjusted life years), achieving MCID at 3 months accurately predicted 12-month MCID with only 87.7% specificity and 87.2% sensitivity. CONCLUSIONS In a prospective registry, patient-reported measures of treatment effectiveness obtained at 3 months correlated with 12-month measures overall in aggregate, but did not reliably predict 12-month outcome at the patient level. Many patients who do not benefit from surgery by 3 months do so by 12 months, and, conversely, many patients reporting meaningful improvement by 3 months report loss of benefit at 12 months. Prospective longitudinal spine outcomes registries need to span at least 12 months to identify effective versus noneffective patient care.
机译：物体卫生保健景观正在迅速转移，以激励照顾护理质量而不是护理数量。质量和结果登记平台位于所有新兴的证据驱动的改革模式的中心，并将用于通知决策者在医疗保健交付中。获得现实世界的注册表结果来自脊柱手术后12个月的患者仍然是一个挑战。作者列出了确定3个月的患者报告的结果是否准确地预测了12个月的结果，因此，3个月的测量系统是否足以识别有效的脊柱护理。方法对单一医疗机构进行退化疾病的腰椎手术的所有患者均注册了一个预期的纵向登记。患者报告的成果仪器（数值评级规模[NRS]，OSWestry残疾指数[ODI]，12项短型健康调查[SF-12]，EQ-5D和Zung Selfrated抑郁尺寸）在基线上进行了录制，并在基线上进行了基准，并且手术后3个月和12个月。进行线性回归以确定3-和12个月结果的独立协会。进行接收器操作特征（ROC）曲线分析，以确定一般健康状态（EQ-5D）和残疾（ODI）的改善是否在3个月内准确地预测12个月内的最低临床重要差异（MCID）。结果共有593名接受选修腰科手术的患者。 3个月和12个月的EQ-5D（r = 0.71; p <0.0001）和ODI之间存在显着相关性（r = 0.70; p <0.0001）;然而，作者观察到达到临床上显着的改善（MCID）阈值的相当大的差异，在每个患者水平上为12个月。对于术后残疾（ODI），11.5％的患者在3个月下达到MCID阈值的患者在12个月下降低于该阈值; 10.5％的患者持续3个月不符合MCID阈值，继续在12个月内提高和最终超过MCID阈值。对于ODI，以3个月实现MCID准确预测12个月MCID，仅具有62.6％的特异性和86.8％的灵敏度。对于术后卫生公用事业（EQ-5D），8.5％的患者损失了3个月至12个月的Mcid阈值改善，而4.0％在术后3到12个月之间获得了Mcid阈值。对于EQ-5D（质量调整的寿命），在3个月内实现MCID，准确地预测12个月MCID，仅具有87.7％的特异性和87.2％的灵敏度。在预期登记处的结论，患者报告的治疗措施在3个月内与总体总体总体的12个月措施相关，但在患者水平上没有可靠地预测12个月的结果。许多不受手术中受益3个月的患者12个月，而且相反，许多患者通过3个月报告了3个月的有意义的改善，报告了12个月的损失。前瞻性纵向脊柱结果注册管理机构需要跨度至少12个月来确定有效的患者护理。

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