Preoperative Patient-Centric Predictors of Postoperative Outcomes in Patients Undergoing Arthroscopic Meniscectomy

Abstract

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a valid and efficient means of collecting patient outcomes in patients with meniscal tears. The studies purpose was to define the minimally clinical important difference (MCID) for PROMIS domains following meniscectomy procedures. Secondary aims included determining the role of pre-operative PROMIS computer adaptive test (CAT) scores in predicting achievement of MCID following meniscectomy. Methods: Patients undergoing arthroscopic meniscectomy who completed PROMIS CAT forms for physical function (PROMIS-PF), pain interference (PROMIS-PI), and depression (PROMIS-D), from July 2017 to July 2019, at a single institution were utilized. MCID was calculated according to the distribution methodology, and receiver operating characteristics (ROC) were utilized to determine if pre-operative scores were predictive of post-operative outcomes. Results: A total of 135 patients met inclusion criteria. Postoperative PROMIS-PF (45.6), PROMIS-PI (54.6), and PROMIS-D (44.1) significantly improved 3 months after surgery (p<0.01). MCID values for PROMIS-PF, PROMIS-PI, and PROMIS-D were 3.5, 3.3, and 4.4, respectively. 62% of the entire cohort met MCID for PROMIS-PF, while 68% met MCID for PROMIS-PI, and 41% met MCID for PROMIS-D. Individuals with PROMIS-PF scores below 34.9 yielded an 82% probability of achieving MCID, while PROMIS-PI scores above 67.5 yielded an 86% probability of achieving MCID and a cutoff of 58.9 for PROMIS-D yielded a 60% probability of achieving MCID, with 90% specificity. Conclusion: Significant portions of patients undergoing meniscectomy achieve MCID in PROMIS-PF, PROMIS-PI, and PROMIS-D, at the 3-month time point. In particular, patients with PROMIS-PF scores of <34.9 are far more likely to achieve MCID for physical function.

Editorial Commentary: Preoperative Patient-Reported Outcomes Measurement Information System Scores Predict Which Patients Will Benefit From Arthroscopic Meniscectomy: To Scope or Not to Scope?

“…It should also be noted that 44% of Okoroha et al's patients achieved MCID at 6 months compared with just 3 months in Franovic et al's study. 6 Our group at Washington University demonstrated statistically significant improvements in PROMIS-PF, PROMIS-PI, and PROMIS-D in 75 patients undergoing arthroscopic meniscectomy. 9 Preoperatively, our patients had decreased PF and increased PI in excess of 1 standard deviation from the general population.…”

“…This idea is especially true of arthroscopic meniscectomydone of the most commonly performed orthopaedic procedures around the world. [3][4][5] In their study entitled System and computer-adaptive testing (PROMIS-CAT) 6 scores to predict those patients who have an increased probability of improving from an arthroscopic partial meniscectomy. This study advances the PROMIS literature by establishing the clinical significance of PROMs and connecting them to clinical decision-making to predict operative benefit based on preoperative data.…”

“…9 It has been described as a powerful tool that provides highly responsive, clinically relevant outcome data. 9 In their study, Franovic et al 6 used the PROMIS domains of physical function (PROMIS-PF), pain interference (PROMIS-PI), and depression (PROMIS-D) surveys to measure patient outcomes both preoperatively and at 3 months postoperatively. All 3 domains showed statistically significant improvement at the 3month follow-up.…”

“…Franovic et al 6 used the distribution-based method to determine MCID values for each domain in contrast to an anchor-based approach. Anchor-based methods compare the change in patient-reported outcome to a second, external measure of change, or anchor that can be objective (i.e., number of pain pills used) or subjective (i.e., improvement in pain).…”

“…Okoroha et al 10 found that the MCID for PROMIS-PF was 2.09 in 73 patients undergoing arthroscopic meniscectomy. This was a smaller, less-comprehensive study than the investigation by Franovic at al., 6 who followed 135 patients and evaluated 3 PROMIS domains (PF, PI, and Dn) rather than just PF. It should also be noted that 44% of Okoroha et al's patients achieved MCID at 6 months compared with just 3 months in Franovic et al's study.…”