New Patient PROMIS Scores of Patients Presenting with Low Back Pain Predict Time to Elective Spine Surgery

This study aims to determine whether Patient-Reported Outcomes Measurement Information System (PROMIS) domain scores can predict elective spine surgery within 1 year of initial clinic evaluation.

A retrospective query for all new patient spine clinic visits with diagnosis codes related to lower back pain was carried out at a single academic institution. A chart review was conducted to collect sociodemographic variables, clinic visit details, and PROMIS domain scores (PF [Physical Function], PI [Pain Interference], Depression, and Global Health-Physical and Global Health-Mental). Patients were divided into Surgery and No Surgery, and for time to surgery, a subanalysis was also carried out.

Overall, 116 (8.4%) of 1,387 new patients underwent surgery within 1 year. Race, Surgeon vs. Advanced Practice Provider (APP), and whether advanced imaging (MRI or CT myelogram) was available for interpretation were statistically associated with undergoing surgery. Patients in the Surgery group had statistically significant worse PROMIS scores in all domains when compared with the No Surgery group, and PROMIS PI was additionally associated with Time to Surgery. Multivariate analysis identified PROMIS PI, race, presence of advanced imaging interpretation, and Surgeon vs. APP as independent predictors of Surgery vs. No Surgery; however, only race and PROMIS PI were independent predictors of Time to Surgery.

Worse new patient PROMIS PI scores were associated with undergoing surgery within one year of initial evaluation. To determine if PROMIS scores may help in a triage capacity to identify which patients are most appropriate for a surgeon visit versus a nonsurgical provider, further research is needed, thereby improving the efficiency of surgical care delivery.