Article

For the majority of patients, spinal surgery is an elective
treatment. The decision as to whether and when to pursue surgery is complicated
and influenced by myriad factors, including pain intensity and duration, impact
on functional activities, referring physician recommendation, and surgeon
preference. By understanding the factors that lead a patient to choose surgery,
we may better understand the decision-making process, improve outcomes, and
provide more effective care. OBJECTIVE: To investigate the relationship between
patient-reported outcome measures (PROMs) at initial physiatry clinic
consultation and subsequent decision to pursue surgical treatment. We
hypothesized that measures of function, pain, and mental health might identify
which patients eventually elect to pursue surgical management. DESIGN:
Retrospective chart review study. SETTING: Physiatry spine clinic in a tertiary
hospital. PATIENTS: A total of 395 consecutive patients meeting our inclusion
criteria were assessed for the presence of chronic pain, self-perceived
disability, history of prior spinal surgery, and provision of chronic opioid
therapy at the time of their initial visit to the integrated spine clinic.
METHODS: Retrospective chart review of all patients presenting to our spine
clinic between August 1, 2014, and July 31, 2015, was performed. At the initial
spine clinic consultation, patients were asked to complete the General Anxiety
Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), Oswestry Disability
Index (ODI), and Patient-Reported Outcomes Measurement Information System
(PROMIS) 10-item short-form questionnaire. The primary outcome was surgical
intervention within 18 months from their first visit to the integrated spine
clinic. We surveyed all patient records until February 2017 for CPT codes
associated with spinal surgery, excluding from analysis those patients who were
lost to follow-up within 1 year of the index visit. Analysis focused on the risk
of spinal surgery, with data points treated as both continuous and categorical
variables. We used logistic regression models to determine whether PROMs, either
alone or in combination, predicted later decision to pursue surgical
intervention. MAIN OUTCOME MEASUREMENTS: Decision to pursue spinal surgery.
RESULTS: The baseline PROM scores spanning functional, mental health, and pain
domains were collected for 94% of the patients presenting to our spine program
during the interval of this study. In total, 146 patients were excluded because
of missing patient-reported outcome data or less than 1 year of follow-up,
leaving 395 patients for analysis. Of these, 40.3% were male with a median age of
58 years, 4.6% presented with a history of prior spinal surgery, and 3.8% were
being treated with chronic opioids at their initial consultation. Male gender (P
= .01) and older age (P = .05) were associated with subsequent surgery, but no
relationship was observed between measured patient-reported outcomes and decision
to undergo spinal surgery within 18 months of the index visit. CONCLUSIONS:
Contrary to our hypothesis, this analysis demonstrates that the PROMs evaluated
in this study, alone are insufficient to identify patients who may elect to
pursue spinal surgery. Male gender and increasing age correlate with decision for
later spinal surgery. LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS