The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Ghogawala, Zoher; Shaffrey, Christopher I.; Asher, Anthony L.; Heary, Robert F.; Logvinenko, Tanya; Malhotra, Neil R.; Dante, Stephen J.; Hurlbert, R. John; Douglas, Andrea F.; Magge, Subu N.; Mummaneni, Praveen V.; Cheng, Joseph; Smith, Justin S.; Kaiser, Michael G.; Abbed, Khalid M.; Sciubba, Daniel M.; Resnick, Daniel K.

doi:10.3171/2013.7.spine1362

Cited by 17 publications

(13 citation statements)

References 18 publications

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“…Obtaining such high rates of follow-up in NeuroPoint-SD required significant resource commitment from all participating institutions. For 1 year of data collection, we previously estimated a cost of more than $1800 per patient, 9 and most NeuroPoint-SD sites incurred more than $18,000 in actual costs to collect data for 1 year (Table 1). By collecting data for 3 months rather than 1 year, the costs per site would be reduced by nearly two-thirds ($7000 vs $18,500).…”

Section: Discussionmentioning

confidence: 99%

“…Based on data from this registry, it was demonstrated that lumbar discectomy and lumbar spinal fusion for degenerative lumbar spondylolisthesis were effective in improving QOL using validated general and disease-specific outcome instruments, the 36-item ShortForm Health Survey (SF-36), Oswestry Disability Index (ODI), and a visual analog scale (VAS). 9 Collection of patient-reported outcomes data in NeuroPoint-SD required dedicated research personnel at multiple institutions, data management and analysis experts, and was associated with significant costs. One of the major drivers of cost, as well as the challenges to overall validity for registries, is the ability to obtain 1-year follow-up on all patients.…”

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confidence: 99%

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Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry

Whitmore

Curran

Ali

et al. 2015

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OBJECT The authors have established a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures using prospectively collected outcomes. Collection of these data requires an extensive commitment of resources from each site. The aim of this study was to determine whether outcomes data from shorter-interval follow-up could be used to accurately estimate long-term outcome following lumbar discectomy. METHODS An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level lumbar discectomy for treatment of disc herniation were included. SF-36 and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Quality-adjusted life year (QALY) data were calculated using SF-6D utility scores. Correlations among outcomes at each follow-up time point were tested using the Spearman rank correlation test. RESULTS One hundred forty-eight patients were enrolled over 1 year. Their mean age was 46 years (49% female). Eleven patients (7.4%) required a reoperation by 1 year postoperatively. The overall 1-year follow-up rate was 80.4%. Lumbar discectomy was associated with significant improvements in ODI and SF-36 scores (p < 0.0001) and with a gain of 0.246 QALYs over the 1-year study period. The greatest gain occurred between baseline and 3-month follow-up and was significantly greater than improvements obtained between 3 and 6 months or 6 months and 1 year(p < 0.001). Correlations between 3-month, 6-month, and 1-year outcomes were similar, suggesting that 3-month data may be used to accurately estimate 1-year outcomes for patients who do not require a reoperation. Patients who underwent reoperation had worse outcomes scores and nonsignificant correlations at all time points. CONCLUSIONS This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. Three-month outcome data may be used to accurately estimate outcome at future time points and may lower costs associated with registry data collection. This registry effort provides a practical foundation for the acquisition of outcome data following lumbar discectomy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry

Whitmore

Curran

Ali

et al. 2015

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“…9,29 In light of the expense and difficulty associated with obtaining real-world PRO data, it has been suggested that short-term outcomes data might, in certain circumstances, serve as an adequate surrogate for long-term data. 25,32,39,43 Given the logistical challenges and financial restraints of collecting long-term patient-reported data at a scalable level, it is vital to understand how well short-term outcomes represent long-term outcomes for both patient populations and individual patients.…”

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Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery

Asher

Chotai

Devin

et al. 2016

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OBJECTIVE Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3-and 12-months was computed. RESULTS The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19% to 27% for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86% and 60% for MCID and 82% and 67% for SCB. CONCLUSIONS Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.

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“…1,3,8,10,11,25 Some of these factors characterized smokers in our study. Furthermore, consistent with other studies, our previous analysis has demonstrated that being a smoker is associated with poor disability outcomes following lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

Asher

Devin

McCutcheon

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEIn this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration.METHODSA total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present.RESULTSIn total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients’ smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients’ propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers.CONCLUSIONSUsing a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

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The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Cited by 17 publications

References 18 publications

Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry

Predictive value of 3-month lumbar discectomy outcomes in the NeuroPoint-SD Registry

Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery

Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

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