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Published on: February 9, 2024
Utility of preoperative comorbidity burden on PROMIS outcomes after lumbar decompression: Cohort matched analysis
Andrea M Roca1, Fatima N Anwar1, Ishan Khosla1
1Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
Insights
Charlson Comorbidity Index burden minimally impacts Patient-Reported Outcomes Measurement Information System (PROMIS) scores after lumbar decompression. While lower comorbidity groups showed early physical function and later anxiety improvements, overall PROMIS outcomes remained largely unaffected by comorbidity burden.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Health Outcomes Research
Background:
- The Charlson Comorbidity Index (CCI) quantifies patient comorbidity burden.
- Patient-Reported Outcomes Measurement Information System (PROMIS) measures health outcomes.
- Limited data exists on CCI's influence on PROMIS outcomes post-lumbar decompression (LD).
Purpose of the Study:
- To evaluate the impact of CCI burden on PROMIS outcomes following elective lumbar decompression.
- To compare PROMIS and legacy outcome measures between patients with mild (CCI <3) and moderate-to-severe (CCI ≥4) comorbidity burden.
Main Methods:
- Retrospective review of 182 patients undergoing elective LD.
- Collection of demographics and PROMIS/legacy PROMs (VR-12, ODI) preoperatively and up to 2 years postoperatively.
- Group comparison based on preoperative CCI scores (<3 vs. ≥4) with statistical analysis and MCID achievement rates.
Main Results:
- No significant preoperative or final follow-up differences in PROMIS/legacy PROMs between CCI groups.
- The lower CCI group (<3) showed improved physical function at 6 weeks (VR-12 PCS, ΔPROM) and reduced anxiety at final follow-up (PROMIS-A ΔPROM).
- No significant differences in achieving Minimum Clinically Important Differences (MCID) for PROMIS or legacy outcomes between groups.
Conclusions:
- Baseline comorbidity burden, as measured by CCI, has a limited effect on PROMIS and legacy outcomes after lumbar decompression.
- While some short-term functional and psychological benefits may favor lower comorbidity patients, overall long-term outcomes are not significantly impacted.
- PROMIS measures appear robust in assessing outcomes across varying comorbidity levels in this patient population.
Abstract:
The influence of Charlson Comorbidity Index (CCI) burden on Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes following lumbar decompression (LD) is limited. The objective of this study is to evaluate CCI burden impact on PROMIS outcomes. Retrospective review of elective LD excluding revision or surgeries for infectious, malignant, or traumatic reasons. Demographics and PROMIS scores collected preoperatively and postoperatively up to 2 years included: PROMIS-Physical Function (PF)/Sleep Disturbance (SD)/Pain Interference (PI)/Anxiety (A), VR-12 Physical/Mental Health Composite scores (VR-12 PCS/MCS)/Oswestry Disability Index (ODI). Patients were divided into two groups based on their preoperative CCI score <3 (mild) or ≥4 (moderate to severe). Descriptive statistical analysis and MCID achievement rate calculations were conducted. A total of 182 patients were included: 93 CCI < 3 and 88 CCI ≥ 4. No significant differences were reported across preoperative PROMIS/legacy PROMs or final follow-up (p > 0.05, all). At 6-weeks, VR-12 PCS and ΔPROM scores indicated improved physician function in the CCI < 3 group (p = 0.020 and p = 0.040, respectively). Significant PROMIS-A ΔPROM score at final post-op was noted for CCI < 3 group (p = 0.026). MCID achievement demonstrated no significant differences for PROMIS outcomes and legacy PROMs. Results demonstrated that PROMIS outcomes were not impacted by a greater baseline comorbidity burden. At 6-weeks, the physical function scores were improved for the lower CCI group, and at final reported less anxiety. Our data suggests that comorbidity burden has a limited effect on PROMIS and legacy outcomes in patients undergoing LD.
