To evaluate the effect of Veterans RAND 12-item health survey mental composite score (VR-12 MCS) on postoperative patient-reported outcome measures (PROMs) after undergoing lateral lumbar interbody ...fusion.
Retrospective data from a single-surgeon database created 2 cohorts: patients with VR-12 MCS ≥ 50 or VR-12 MCS < 50. Preoperative, 6-week, and final follow-up (FF)- PROMs including VR-12 MCS/physical composite score (PCS), 12-item Short Form health survey (SF-12) MCS/PCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), visual analogue scale (VAS)-back/leg pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected. ∆6-week and ∆FF-PROMs were calculated. Minimal clinically important difference (MCID) achievement rates were determined from established cutoffs from the literature. For intercohort comparison, chi-square analysis was used for categorical variables, and Student t-test for continuous variables.
Seventy-nine patients were included; 25 were in VR-12 MCS < 50. Mean postoperative follow-up time was 17.12 ± 8.43 months. The VR-12 MCS < 50 cohort had worse VR-12 PCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, and ODI scores preoperatively (p ≤ 0.014, all), worse VR-12 MCS/PCS, SF-12 MCS, PROMIS-PF, PHQ-9, and ODI scores at 6-week postoperatively (p ≤ 0.039, all), and worse VR-12 MCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, VAS-LP, and ODI scores at FF (p ≤ 0.046, all). The VR-12 MCS < 50 cohort showed greater improvement in VR-12 MCS and SF-12 MCS scores at 6 weeks and FF (p ≤ 0.005, all). The VR-12 MCS < 50 cohort experienced greater MCID achievement for VR-12 MCS, SF-12 MCS, and PHQ-9 (p ≤ 0.006, all).
VR-12 MCS < 50 yielded worse mental health, physical function, pain and disability postoperatively, yet reported greater improvements in magnitude and MCID achievement for mental health.
Few studies have established the minimum clinically important difference (MCID) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for physical function and ...pain.
To establish MCID for physical function and pain patient-reported outcome measures (PROMs) for MIS-TLIF through anchor- and distribution-based methods using the Oswestry Disability Index (ODI) as the anchor.
Ninety-eight patients undergoing primary MIS-TLIF with preoperative and 1-year postoperative ODI scores were identified. MCID was calculated using anchor- and distribution-based methods. ODI responders were classified as patients who decreased by 1 disability classification. PROMs of Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Visual Analog Scale (VAS) back/leg, and ODI were collected preoperatively and 1-year postoperatively. Anchor-based methods were average change, minimum detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis. Distribution-based methods were standard error of measurement, receiver change index, effect size, and 0.5 ∗ ΔSD.
Anchor-based methods ranged from 4.2 to 11.9 for PROMIS-PF, 6.0 to 15.8 for SF-12 PCS, 1.8 to 4.6 for VAS back, and 2.1 to 4.0 for VAS leg. The area under the curve for receiver operating characteristic analysis ranged from 0.66 to 0.81. Distribution-based methods ranged from 1.1 to 3.9 for PROMIS-PF, 1.6 to 10.4 for SF-12 PCS, 0.5 to 1.6 for VAS back, and 0.6 to 1.8 for VAS leg.
Patients undergoing MIS-TLIF had a wide range of MCID values. The receiver operating characteristic curve was selected as the most clinically appropriate method. The corresponding MCID values were 4.2 for PROMIS-PF, 6.8 for SF-12 PCS, 1.8 for VAS back, and 2.4 for VAS leg.
Workers' compensation (WC) status tends to negatively affect patient outcomes in spine surgery. This study aims to evaluate the potential effect of WC status on patient-reported outcomes (PROs) after ...cervical disc arthroplasty (CDR) at an ambulatory surgical center (ASC).
A single-surgeon registry was retrospectively reviewed for patients who had undergone elective CDR at an ASC. Patients with missing insurance data were excluded. Propensity score-matched cohorts were generated by the presence or lack of WC status. PROs were collected preoperatively and at 6-week, 12-week, 6-month, and 1-year time points. PROs included the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) neck and arm pain, and Neck Disability Index. PROs were compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups.
Sixty-three patients were included, with 36 without WC (non-WC) and 27 with WC. The non-WC cohort demonstrated postoperative improvement in all PROs at all time points, with the exception of VAS arm past the 12-week point (P ≤ 0.030, all). The WC cohort demonstrated postoperative improvement in VAS neck at 12-week, 6-month, and 1-year time points (P ≤ 0.025, all). The WC cohort improved in VAS arm and Neck Disability Index at the 12-week and 1-year points as well (P ≤ 0.029, all). The non-WC cohort reported superior PRO scores in every PRO at one or more postoperative time points (P ≤ 0.046, all). The non-WC cohort demonstrated higher rates of minimum clinically important difference achievement in PROMIS-PF at 12 weeks (P ≤ 0.024).
Patients with WC status undergoing CDR at an ASC may report inferior pain, function, and disability outcomes compared with those with private or government-provided insurance. Perceived inferior disability in WC patients persisted into the long-term follow-up period (1 year). These findings may aid surgeons in setting realistic preoperative expectations with patients at risk of inferior outcomes.
There is a gap in the literature comparing time to minimum clinically important difference (MCID) achievement and factors associated with delayed MCID achievement for patient-reported outcome ...measures (PROMs) between the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterior lumbar interbody fusion (ALIF).
To compare time to MCID achievement and factors associated with delayed MCID achievement the PROMs of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg.
Retrospective review.
Three-hundred and fourteen patients were identified, with 224 patients undergoing MIS-TLIF and 90 patients undergoing ALIF.
Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg.
PROMs of patients undergoing MIS-TLIF or ALIF were collected at preoperative and postoperative 6-week, 12-week, 6-month, 1-year, and 2-year postoperative time points. MCID achievement was calculated through comparison of change in PROMs to previously determined values. Time to MCID achievement was compared through Kaplan-Meier survival analysis. Predictors of delayed time to MCID achievement were determined through multivariable Cox regression.
Three-hundred and fourteen patients were identified, with 224 patients undergoing MIS-TLIF and 90 patients undergoing ALIF. MCID achievement rates were higher in MIS-TLIF patients for ODI (68.8% vs 53.3%, p=0.010) and VAS leg (71.4% vs 51.1%, p=0.001), while MCID achievement rates were not significant for PROMIS-PF (74.1% vs 68.9%) and VAS back (80.4% vs 74.4%). In patients who achieved MCID, the mean postoperative time to achieve MCID in weeks was 61.28±37.88 for PROMIS-PF, 49.60±34.45 for ODI, 47.42±36.65 for VAS back, and 44.02±34.07 for VAS leg in MIS-TLIF patients, while the time to MCID achievement was 51.81±35.88 for PROMIS-PF, 41.25±29.57 for ODI, 32.90±29.34 for VAS back, and 32.14±27.11 for VAS leg in ALIF patients. Accounting for patients who failed to achieve MCID, Kaplan-Meier survival analysis revealed significantly faster MCID achievement times in ODI and VAS leg for MIS-TLIF patients (p≤0.026, both). Multivariable Cox regression revealed early predictors of MCID achievement of elevated baseline PROMs of VAS back and VAS leg and diagnosis of degenerative disc disease (HR 1.03-1.54) and late predictors of ALIF procedure, Hispanic and Asian ethnicity, workers’ compensation, elevated baseline PROMIS-PF, and diagnosis of isthmic spondylolisthesis (HR 0.27-0.95). Elevated baseline ODI was an early and late predictor for PROMIS-PF (HR 0.98) and ODI, respectively (HR 1.03).
Independent of surgical procedure, most patients achieved MCID within 2 years of surgery. Patients undergoing ALIF achieved MCID later in disability and leg pain compared to patients undergoing MIS-TLIF. Significant factors for early MCID achievement were elevated baseline pain scores and diagnosis of degenerative disc disease. Significant factors for late MCID achievement were patients undergoing ALIF, elevated baseline physical function, Hispanic or Asian ethnicity, workers’ compensation, and diagnosis of isthmic spondylolisthesis. Elevated baseline disability was an early and late MCID predictor for physical function and disability, respectively. Surgeons may utilize this information to convey expectations to patients.
This abstract does not discuss or include any applicable devices or drugs.
No study has compared minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) to lateral lumbar interbody fusion (LLIF) in time to achieve the minimum clinically important difference ...(MCID) and factors associated with delayed MCID achievement.
To compare time to achieve MCID between MIS-TLIF and LLIF and to evaluate the factors associated with delayed time to achieve MCID for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg.
Retrospective review.
Patients undergoing MIS-TLIF or LLIF with preoperative PROMIS-PF, ODI, VAS back, and VAS leg were retrospectively reviewed through a single-surgeon database. Two-hundred and twenty-five patients were identified, with 153 patients undergoing MIS-TLIF and 72 patients undergoing LLIF.
Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg.
Patients undergoing MIS-TLIF or LLIF with preoperative PROMIS-PF, ODI, VAS back, and VAS leg were retrospectively reviewed through a single-surgeon database. PROMs were collected at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative time points. MCID achievement was determined through comparison of change in PROMs to established values in literature. Kaplan-Meier survival analysis was utilized to determine time to achieve MCID. Predictive values of delayed MCID achievement were determined through multivariable Cox regression analysis.
Two-hundred and twenty-five patients were identified, with 153 patients undergoing MIS-TLIF and 72 patients undergoing LLIF. Overall MCID achievement rates for MIS-TLIF patients were 74.1% for PROMIS-PF, 67.5% for ODI, 71.8% for VAS back, and 65.8% for VAS leg, while MCID achievement rates for LLIF patients were 74.7% for PROMIS-PF, 62.8% for ODI, 71.7% for VAS back, and 69.7% for VAS leg. The mean time to achieve MCID in weeks for MIS-TLIF patients was 24.51±38.41 for PROMIS-PF, 32.10±35.43 for ODI, 32.52±35.37 for VAS back, and 30.28±33.42 VAS leg, while mean time for LLIF patients were 21.03±30.01 for PROMIS-PF, 22.68±29.59 for ODI, 26.91±30.49 for VAS back, and 27.34±29.29 for VAS leg. Surgical procedure was only significant in Kaplan-Meier survival analysis for PROMIS-PF, where LLIF patients achieved MCID significantly earlier (p = 0.011). Multivariable Cox regression demonstrated early predictors of MCID achievement for elevated preoperative VAS back, VAS leg, and ODI scores, diagnosis of hypertension, and diagnosis of herniated disc (HR 1.03-2.82). Late predictors of MCID achievement were diagnosis of diabetes, Hispanic ethnicity, workers’ compensation, and increased preoperative PROMIS-PF (HR 0.33-0.95).
Independent of surgical procedure, most patients achieved MCID within 1-year of surgery. Patients undergoing LLIF achieved MCID earlier in physical function compared to patients undergoing MIS-TLIF. Significant factors for early MCID achievement were elevated baseline disability and pain scores, diagnosis of hypertension, and diagnosis of herniated disc. Significant factors for late MCID achievement were diagnosis of diabetes, Hispanic ethnicity, workers’ compensation, and elevated baseline physical function. These factors may be useful in managing postoperative expectations for patients.
This abstract does not discuss or include any applicable devices or drugs.
The influence of preoperative mental health on postoperative outcomes has been well-studied; however, there is limited literature available assessing the correlation between mental health at time of ...outcome assessment following surgery.
The goal of this study is to determine the degree to which pain, physical function, and disability outcomes may be affected by the mental health of patients at time of survey in the anterior cervical discectomy and fusion (ACDF) population.
Retrospective correlation study.
Patients who had undergone ACDF, excluding those with acute trauma, infection, or malignancy as indications for surgery, were selected, totaling 618 participants.
Outcomes studied included 12-item Short Form (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), visual analog scale (VAS) back and leg pain, and Neck Disability Index (NDI) scores.
A prospectively maintained single-surgeon registry was searched for patients who had undergone ACDF, excluding those with acute trauma, infection, or malignancy as indication for surgery. Patient-reported outcomes (PROs) were collected preoperatively and at several time points up to 2 years postoperatively. Outcomes studied included 12-item Short Form (SF-12) Physical Component Score (PCS) and Mental Component Score (MCS), Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), visual analog scale (VAS) back and leg pain, and Neck Disability Index (NDI) scores. Relationships between mental health, SF-12 MCS and PHQ-9, were compared to each other at each time period studied via Pearson's correlation tests.
Six hundred and eighteen patients were included in the study. SF-12 MCS correlated positively with PROMIS-PF at all time points (|r|=0.373-0.509) and with SF-12 PCS at 6 months (r=0.256) and 1-year (r=0.427). SF-12 MCS negatively correlated at all periods with VAS Neck (|r|=0.319-0.634), VAS Arm (|r|=0.248-0.634), and NDI (|r|=0.449-0.629) (p≤0.034, all). PHQ-9 negatively correlated at all periods with PROMIS PF (|r|=0.443-0.757) and SF-12 PCS at all periods (|r|=0.359-0.722). At all periods, PHQ-9 positively correlated with VAS Neck (|r|=0.495-0.683), VAS Arm (|r|=0.332-0.701), and NDI (|r|=0.582-0.816) (p≤0.021, all).
Poor mental health at time of outcome collection was associated with inferior physical function, increased neck and arm pain, and increased disability regardless of mental health form used. PHQ-9 had a stronger correlation with all outcome measures. Mental health is potentially a large contributor to inferior outcomes following ACDF. Optimization of mental health in both the preoperative and postoperative stages may lead to improved patient-reported outcomes.
This abstract does not discuss or include any applicable devices or drugs.
Background
Limited spine literature has studied the strength of association of mental health with other outcomes at time of survey collection. We aim to evaluate the degree to which mental health ...correlates with outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at several postoperative periods.
Methods
Patients having undergone elective MIS-TLIF were searched within a retrospective single-surgeon database. Five hundred eighty-five patients were included. Patient-reported outcomes (PROs) including Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), 12-item Short Form Physical Component Score (SF-12 PCS) and Mental Component Score (SF-12 MCS), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) scores were collected preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year periods. Pearson’s correlation tests were used to evaluate the association between both SF-12 MCS and PHQ-9 scores to other PROs at each period.
Results
SF-12 MCS correlated with PROMIS PF (|
r
|= 0.308–0.531), SF-12 PCS (|
r
|= 0.207–0.328), VAS back (|
r
|= 0.279–0.474), VAS leg (|
r
|= 0.178–0.395), and ODI (|
r
|= 0.450–0.538) at all time points (
P
≤ 0.021, all) except for preoperative SF-12 PCS and 1-year VAS leg. PHQ-9 correlated with PROMIS PF (|
r
|= 0.366–0.701), SF-12 PCS (|
r
|= 0.305–0.568), VAS back (|
r
|= 0.362–0.714), VAS leg (|
r
|= 0.319–0.694), and ODI (|
r
|= 0.613–0.784) at all periods (
P
< 0.001, all).
Conclusion
Poor mental health scores were correlated with lower physical function, elevated pain scores, and higher disability. PHQ-9 scores demonstrated stronger correlation in all relationships compared to SF-12 MCS. Optimization of patient mental health may lead to improved patient perception regarding function, pain, and disability following MIS-TLIF.
We sought to assess correlational relationship between mental health and outcomes following lateral lumbar interbody fusion (LLIF).
Patients who had undergone LLIF were identified. Patients with ...indications for surgery including infection, trauma, or malignancy were excluded. Patient-reported outcomes (PROs) included short-form (SF)-12 Mental Component Score (MCS)/Patient Health Questionnaire (PHQ)-9/Patient-Reported Outcomes Measurement Information System−Physical Function (PROMIS-PF)/12-Item Short-Form Physical Component Score (SF-12 PCS)/Visual Analog Scale (VAS) back and leg pain/Oswestry Disability Index (ODI) and were collected preoperatively and at several postoperative time points extending to 1 year. Pearson correlation tests were used to compare the 12-item Short Form Mental Component Score (SF-12 MCS) and PHQ-9 with the other PROs.
We included 124 patients. SF-12 MCS positively correlated with PROMIS-PF at 6 months (r = 0.466) and SF-12 PCS preoperatively (r = 0.287) and at 6 months (r = 0.419) (P ≤ 0.041, all). SF-12 MCS negatively correlated with VAS back preoperatively (r = −0.315), at 12 weeks (r = −0.414), and at 6 months (r = −0.746); VAS leg at 12 weeks (r = −0.378); and ODI preoperatively (r = −0.580) (P ≤ 0.023, all). PHQ-9 negatively correlated with PROMIS-PF at all periods except 12 weeks (range: r = −0.357 to −0.566, P ≤ 0.017, all) and SF-12 PCS preoperatively, at 6 weeks, and at 6 months (range: r = −0.363 to −0.562, P ≤ 0.022, all). PHQ-9 positively correlated with VAS back at all periods before 1-year (range: r = 0.415–0.690, P ≤ 0.001, all), VAS leg at 12-weeks (r = 0.467) and 6-months (r = 0.402) (P ≤ 0.028, both), and ODI at all periods except 6-months (range: r = 0.413–0.637, P ≤ 0.008, all).
Better mental health scores correlated with superior physical function, pain, and disability scores when measured by both SF-12 MCS and PHQ-9. PHQ-9 more consistently reported significant correlation to all outcomes measured when compared to SF-12 MCS.
To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression.
Patients ...undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively.
Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain.
Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement.
Di(2-ethylhexyl) phthalate (DEHP) is a large-molecular-weight phthalate added to plastics to impart versatile properties. DEHP can be found in medical equipment and devices, food containers, building ...materials, and children's toys. Although DEHP exposure occurs most commonly by ingesting contaminated foods in the majority of the population, its effects on the gastrointestinal tract have not been well studied. Therefore, we analyzed the effects of subchronic exposure to DEHP on the ileum and colon morphology, gene expression, and immune microenvironment. Adult C57BL/6 female mice were orally dosed with corn oil (control, n = 7) or DEHP (0.02, 0.2, or 30 mg/kg, n = 7/treatment dose) for 30–34 days. Mice were euthanized during diestrus, and colon and ileum tissues were collected for RT-qPCR and immunohistochemistry. Subchronic DEHP exposure in the ileum altered the expression of several immune-mediating factors (Muc1, Lyz1, Cldn1) and cell viability factors (Bcl2 and Aifm1). Similarly, DEHP exposure in the colon impacted the gene expression of factors involved in mediating immune responses (Muc3a, Zo2, Ocln, Il6, and Il17a); and also altered the expression of cell viability factors (Ki67, Bcl2, Cdk4, and Aifm1) as well as a specialized epithelial cell marker (Vil1). Immunohistochemical analysis of the ileum showed DEHP increased expression of VIL1, CLDN1, and TNF and decreased number of T-cells in the villi. Histological analysis of the colon showed DEHP altered morphology and reduced cell proliferation. Moreover, in the colon, DEHP increased the expression of MUC2, MUC1, VIL1, CLDN1, and TNF. DEHP also increased the number of T-cells and Type 2 immune cells in the colon. These data suggest that subchronic DEHP exposure differentially affects the ileum and colon and alters colonic morphology and the intestinal immune microenvironment. These results have important implications for understanding the effects of DEHP on the gastrointestinal system.
Display omitted
•First study evaluating the effect of DEHP exposure to environmentally relevant doses on the ileum and colon in female mice.•Subchronic DEHP exposure resulted in inflammatory changes in the ileum and colon.•Subchronic DEHP exposure decreases cell proliferation in colon, but not in ileum.•Colon is more susceptible to the effects of DEHP exposure than ileum.
