Robert G Whitmore1,2, Jill N Curran1,2, Zarina S Ali3, Praveen V Mummaneni4, Christopher I Shaffrey5, Robert F Heary6, Michael G Kaiser7, Anthony L Asher8, Neil R Malhotra3, Joseph S Cheng9, John Hurlbert10, Justin S Smith5, Subu N Magge1, Michael P Steinmetz11, Daniel K Resnick12, Zoher Ghogawala1,2. 1. Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; 2. Wallace Trials Center, Greenwich Hospital, Greenwich, Connecticut; 3. Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; 4. Department of Neurological Surgery, University of California, San Francisco, California; 5. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia; 6. Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; 7. Department of Neurosurgery, Columbia University, New York, New York; 8. Carolina Neurosurgery & Spine, Charlotte, North Carolina; 9. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; 10. Department of Clinical Neurosciences, University of Calgary Spine Program, Calgary, Alberta, Canada; 11. MetroHealth Medical Center, Cleveland, Ohio; 12. Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Abstract
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.
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.
Entities:
Keywords:
IRB = institutional review board; MCID = minimum clinically important difference; ODI = Oswestry Disability Index; QALY; QALY = quality-adjusted life year; QOL = quality of life; SF-36 = 36-Item Short-Form Health Survey; SPORT = Spine Patient Outcomes Research Trial; VAS = visual analog scale; correlation; discectomy; lumbar; outcome
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