Thursday’s Best Paper presentations included the results of studies exploring the benefits of patient reported outcomes (PROs) in determining value of care and the impact of opioid use on postoperative outcomes in adult spinal deformity (ASD) patients.
Richard L. Skolasky, ScD, of Johns Hopkins University in Baltimore, MD, presented the results of a prospective cohort study that compared the use of the Patient Reported Outcomes Measurement Information System (PROMIS) metrics with legacy measures to identify those with anxiety and depression among patients at preoperative evaluation for spine surgery.
“In our study, we developed and validated an algorithm to estimate health utility using the PROMIS health domains that were identified as important by spine patients — pain, physical function, fatigue, anxiety, depression, sleep disturbance and satisfaction with participation in social roles,” Dr. Skolasky said.
The study utilized data prospectively collected on 439 patients with cervical and/or lumbar spine disease who were randomly allocated to a derivation cohort and a validation cohort in a 1:1 fashion. In the derivation sample, quality-adjusted life years (QALYs) were estimated, using linear regression, as a function of PROMIS health domains. Model fit statistics were used to determine the most parsimonious QALY estimation equation. In the validation sample, QALYs were calculated using the QALY estimation equation. QALYs based on the PROMIS health domains were correlated with QALYs derived from the Medical Outcomes Study Short Form 12, version 2 (SF12v2). Sensitivity analyses were also conducted.
“Based on our findings, we believe our final QALY estimating equation can be used by clinicians and health researchers to estimate the impact that medical care or other intervention has on a patient’s quality of life — a key component of measuring the value of health care,” Dr. Skolasky said. “Providers, researchers and industry should be encouraged to measure the quality of health care delivered, but when we think of measuring, it’s not only what we measure, it’s also about developing a strategy to encourage patients to continue to provide this information to us.”
In a subsequent presentation, Micheal Raad, MD, also of Johns Hopkins University, presented the results of a retrospective study from a prospective ASD surgery database that compared the outcomes following ASD surgery between patients taking opioids daily and those who were not.
“Given the high levels of pain, adult spinal deformity patients have relatively high rates of opioid consumption; however, no previously published reports have attempted to investigate the effects of preoperative opioid use on postoperative outcomes in this patient population,” Dr. Raad said. “The aim of our study was to describe and investigate opioid use in these patients and determine its effects on the postoperative course.”
Dr. Raad and his colleagues looked at 819 patients who underwent surgery for adult spinal deformity. They found that patients who reported heavy opioid use preoperatively were at a significantly higher risk of requiring a prolonged length of intensive care unit stay and total length of hospital stay. They also looked at a robust set of potential confounders — including levels of pain, demographics, radiographic deformity and surgical invasiveness — and found the correlation between opioid use and postoperative outcomes was still present after controlling for all potential confounders.
“Our results clearly show that daily narcotic use is independently associated with a longer hospital stay and is predictive of daily narcotic use at six weeks and two years postoperatively,” Dr. Raad said. “These patients were also more likely to have higher levels of disability at two years. These findings highlight a very important issue in ASD surgery and suggest that physicians should consider a patient’s use of opioids preoperatively as a risk factor.”