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Published on: June 16, 2023
Comparison Between Short-Term and 1-Year Patient-Reported Outcome Measures After Anterior Cervical Discectomy and
Jonathan Dalton1, Robert J Oris, Omar Tarawneh
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Study Design:
Retrospective study of adult patients who underwent 1-4 level primary elective ACDF at a tertiary care center (2014-2022).
Objective:
This study's purpose was to evaluate the timing of patient-reported outcome measure (PROM) changes up to a year after anterior cervical discectomy and fusion (ACDF) and to identify any plateaus in improvement within this time period. The goal was to provide information for patients/providers and minimize unnecessary extended PROM collection.
Summary Of Background Data:
ACDF is a largely successful procedure, but there is minimal literature evaluating the optimal time frame for PROM collection after ACDF, despite increasing emphasis on PROMs to evaluate outcomes and determine reimbursement.
Methods:
Demographics, including age, sex, BMI, insurance, and distressed community index, were collected. Outcomes included 30- and 90-day readmissions, revisions, and PROMs (preoperative and at 3, 6, and 12 months postoperative). PROMs included modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) Neck/Arm, Physical Component Summary (PCS-12), and Mental Component Summary (MCS-12) scores. The percentage of patients achieving minimum clinically important differences (MCID) was calculated for VAS Neck/Arm and mJOA.
Results:
Seven hundred sixty-eight patients (49.1% female, mean age: 56.5 y) underwent ACDF (49% 1-2-level, 23.3% 3-level, and 6.77% 4-level). Ninety-day readmission and 1-year revision rates were 0.91% and 3.52%, respectively. Across all PROMs, patients improved significantly from baseline to 3 months (P<0.001). However, no differences were noted across PROMs in the 3-6 and 6-12 months intervals postoperatively. Pairwise comparison of MCID achievement between the different postoperative timepoints showed no differences after 3 months.
Conclusions:
This study showed that PROM values and the likelihood of MCID achievement plateau 3 months after ACDF, challenging the necessity of PROM follow-up up to a year. Reassessing the utility of long-term PROM collection may lead to more inclusive and cost-efficient investigations in spine surgery outcomes, without compromising data quality.