PROMIS PF in the Evaluation of Postoperative Outcomes in Workers’ Compensation Patients Following Anterior Cervical Discectomy and Fusion

Abstract

Study Design: This was a retrospective cohort study. Objective: To determine the improvement of clinical outcomes in Workers’ Compensation (WC) patients compared with non-WC patients utilizing Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF) following anterior cervical discectomy and fusion (ACDF). Summary of Background Data: To our knowledge, there has not been a study to evaluate clinical outcomes of WC patients utilizing the PROMIS PF survey. Methods and Materials: Patients undergoing a primary, 1 to 3-level ACDF were retrospectively reviewed and stratified according to insurance (WC and non-WC). Demographic and perioperative characteristics were compared using χ2 test and independent t tests. Change in PROMIS PF scores was calculated using paired t tests. Differences in postoperative PROMIS PF scores and changes in PROMIS PF from baseline were compared using linear regression. Results: In total, 124 1 to 3-level ACDF patients were included: 36 had WC insurance and 88 had non-WC insurance. WC patients were younger and more likely to be obese. WC patients reported significantly lower PROMIS PF scores preoperatively and at 6 weeks, 12 weeks, and 6 months timepoints. However, both cohorts reported comparable PROMIS PF scores at the 1-year timepoint. WC patients demonstrated similar improvements from baseline through 1-year postoperatively compared with non-WC patients. For both non-WC and WC cohort, the change in the postoperative PROMIS PF score from baseline was significant at 3 months, 6 months, and 1 year. However, in both cohorts, the change in the postoperative PROMIS PF score from baseline was not significantly different at 6 weeks. Conclusions: In our study, WC patients had worse baseline physical function as indicated by lower preoperative PROMIS PF scores and reported lower PROMIS PF scores postoperatively. However, there were no significant differences when comparing the postoperative change from baseline between the cohorts. Both cohorts experienced significant postoperative improvements from baseline. This study established that PROMIS PF is an effective tool to evaluate recovery of WC patients following ACDF.

Workers' Compensation Association With Clinical Outcomes After Anterior Cervical Diskectomy and Fusion

“…22 Although the findings of this study regarding pain improvement are comparatively different from previous investigations, our results were able to reproduce previous observations regarding PF and disability. Yoo et al 9 established that WC patients had significantly worse PF scores as measured by PROMIS PF through the 6-mo time point, which aligned well with our study. Interestingly, Carreon et al 11 demonstrated that disability and PF were significantly worse in WC patients at the 2-yr mark after posterolateral lumbar fusion, which is somewhat contrasting to our results, whereby non-WC and WC groups did not demonstrate significant differences in SF-12 PCS or PROMIS PF at the 1-yr time point.…”

“…Past studies evaluating PROMIS PF after ACDF also reported a significantly lower PF score at the preoperative time point. 9 Outside of spine surgery, studies involving shoulder arthroplasty patients also established that patients receiving WC benefits reported worse pain and PF scores. 21 Interestingly, our NDI preoperative scores were significantly higher in WC patients and contrast to those reported by previous cervical disk arthroplasty studies 20 ; however, studies in ACDF patients reported that a higher preoperative NDI was a negative predictor of outcomes.…”

“…4,5 Specific to ACDF procedures, previous studies concluded that outcomes such as return to work, adverse events, fusion and revision rates, and physical function (PF) can be both significantly and nonsignificantly affected by WC status. 6-9 In particular, Goldberg et al 7 reported no significant difference in surgical outcomes between the 2 groups while Tabaraee et al 8 found lower fusion rates and higher visual analog scale (VAS) scores in WC patients after ACDF. The literature regarding lumbar surgery is more expansive and includes studies that assess outcomes using VAS, Oswestry Disability Index, and Short Form (SF)-36 Physical Composite Score (PCS) scores after anterior lumbar interbody fusion and posterolateral lumbar fusion procedures.…”

Commentary: Workers' Compensation Association With Clinical Outcomes Following Anterior Cervical Diskectomy and Fusion

“…A handful of studies have investigated the unique considerations for cervical surgery in patients receiving WC; despite some disagreement, most conclude that WC status is associated with worse preoperative patient-reported outcome measures (PROMs), delayed improvement in said measures in the immediate postoperative period, and even elevated rates of nonunion and reoperation. 1-5 These subpar outcomes are not unique to spinal disease WC patients because similar trends have been observed in claims pertaining to arm/shoulder, hand, and knee disease as well. 6 Although these general trends have been studied previously, the differential rate in improvement between the WC and non-WC cohorts in PROMS up to the 6-month time point is an interesting finding of WC anterior cervical diskectomy and fusion (ACDF) study.…”

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

“…Previously, Yoo et al [ 17 ] have demonstrated that for anterior cervical diskectomy and fusion (ACDF), WC patients have lower preoperative and postoperative PROMIS-PF than non-WC patients. However, both cohorts experienced similar postoperative changes from baseline.…”