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Impact of Preoperative PROMIS PF on Outcomes Following Cervical Disc Replacement
Cole T Kwas1, Tejas Subramanian1,2, Joshua Zhang1
1Department of Orthopaedic Surgery, Hospital for Special Surgery.
Study Design:
Retrospective cohort study.
Objective:
To assess the impact of preoperative PROMIS PF scores on postoperative pain, narcotics consumption, return to activities, and PROMs following CDR.
Summary Of Background Data:
There is limited data regarding the impact of baseline PROMIS PF on outcomes for patients undergoing CDR.
Methods:
Patients undergoing primary 1- or 2-level CDR for degenerative pathology with minimum 6-month follow-up were included and separated into a high disability group (≤40 preoperative PROMIS PF) and a low disability group (>40 preoperative PROMIS PF). Analyses were conducted for the early (<6 mo) and late (≥6 mo) postoperative timepoints. Linear and logistic regressions were performed to determine the association of preoperative PROMIS PF group with postoperative pain, narcotics consumption, time to discontinue narcotics, return to driving and working, PROMs, and MCID achievement.
Results:
A total of 93 patients were included. Patients in the high disability group were younger (41.5±8.4 vs. 45.3±7.6, P =0.026) and had a higher proportion of female patients (58.7% vs. 25.6%, P =0.001). Patients with higher disability experienced similar postoperative pain scores, narcotics consumption, time to discontinue narcotics, and return to driving and working timelines as patients with lower disability but demonstrated poorer PROM scores at early follow-up. However, patients with higher disability experienced greater changes in NDI and PROMIS PF scores at both early and late follow-up, VAS-Neck and Arm and SF-12 PCS scores at late follow-up, and also achieved the MCID at a higher rate for multiple PROMs.
Conclusion:
Patients with higher preoperative disability, as determined by PROMIS PF, experience similar postoperative pain scores, narcotics consumption, time to discontinue narcotics, and return to activities as compared with patients with lower preoperative disability undergoing CDR as well as greater absolute improvements and MCID achievement rates for most PROMs. These findings may be useful in setting postoperative expectations for outcomes following CDR.
Level Of Evidence:
Level III.
