Akshay Sharma1,2,3, Joseph E Tanenbaum1,2,4, Olivia Hogue1,5, Syed Mehdi6, Sagar Vallabh1,2,4, Emily Hu1,2,4, Edward C Benzel1,3, Michael P Steinmetz1,3,7, Jason W Savage1,4. 1. Center for Spine Health, Cleveland Clinic, Cleveland, Ohio. 2. Case Western Reserve University School of Medicine, Cleveland, Ohio. 3. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio. 4. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio. 5. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 6. Department of Orthopedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. 7. Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Deformity reconstruction surgery has been shown to improve quality of life (QOL) in cases of adult spinal deformity (ASD) but is associated with significant morbidity. OBJECTIVE: To create a preoperative predictive nomogram to help risk-stratify patients and determine which would likely benefit from corrective surgery for ASD as measured by patient-reported health-related quality of life (HRQoL). METHODS: All patients aged 25-yr and older with radiographic evidence of ASD and QOL data that underwent thoracolumbar fusion between 2008 and 2014 were identified. Demographic and clinical parameters were obtained. The EuroQol 5 dimensions questionnaire (EQ-5D) was used to measure HRQoL preoperatively and at 12-mo postoperative follow-up. Logistic regression of preoperative variables was used to create the prognostic nomogram. RESULTS: Our sample included data from 191 patients. Fifty-one percent of patients experienced clinically relevant postoperative improvement in HRQoL. Seven variables were included in the final model: preoperative EQ-5D score, sex, preoperative diagnosis (degenerative, idiopathic, or iatrogenic), previous spinal surgical history, obesity, and a sex-by-obesity interaction term. Preoperative EQ-5D score independently predicted the outcome. Sex interacted with obesity: obese men were at disproportionately higher odds of improving than nonobese men, but obesity did not affect odds of the outcome among women. Model discrimination was good, with an optimism-adjusted c-statistic of 0.739. CONCLUSION: The predictive nomogram that we developed using these data can improve preoperative risk counseling and patient selection for deformity correction surgery.
BACKGROUND:Deformity reconstruction surgery has been shown to improve quality of life (QOL) in cases of adult spinal deformity (ASD) but is associated with significant morbidity. OBJECTIVE: To create a preoperative predictive nomogram to help risk-stratify patients and determine which would likely benefit from corrective surgery for ASD as measured by patient-reported health-related quality of life (HRQoL). METHODS: All patients aged 25-yr and older with radiographic evidence of ASD and QOL data that underwent thoracolumbar fusion between 2008 and 2014 were identified. Demographic and clinical parameters were obtained. The EuroQol 5 dimensions questionnaire (EQ-5D) was used to measure HRQoL preoperatively and at 12-mo postoperative follow-up. Logistic regression of preoperative variables was used to create the prognostic nomogram. RESULTS: Our sample included data from 191 patients. Fifty-one percent of patients experienced clinically relevant postoperative improvement in HRQoL. Seven variables were included in the final model: preoperative EQ-5D score, sex, preoperative diagnosis (degenerative, idiopathic, or iatrogenic), previous spinal surgical history, obesity, and a sex-by-obesity interaction term. Preoperative EQ-5D score independently predicted the outcome. Sex interacted with obesity: obesemen were at disproportionately higher odds of improving than nonobese men, but obesity did not affect odds of the outcome among women. Model discrimination was good, with an optimism-adjusted c-statistic of 0.739. CONCLUSION: The predictive nomogram that we developed using these data can improve preoperative risk counseling and patient selection for deformity correction surgery.