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Minimum clinically important difference able to measure cervical surgery outcome
The concept of minimum clinically important difference or MCID can be an accurate tool to measure surgical outcome if paired with the correct anchor-based and distribution-based approaches in patients with subaxial degenerative cervical spine disease, according to this study.
“We introduce an external and arguably more objective criterion, surgeon ratings, as a novel anchor for this surgical population. Surgeon ratings were compared with two other well-established subjective anchors (HTI [health transition item] and patient overall status). In comparison with the two other anchors, surgeon ratings consistently gave us the greatest AUC (area under the receiver operating characteristic curve) for different patient reported outcome (PRO) surveys. Our results suggest that, among the analyzed methods, surgeon ratings may be the best anchor for MCID calculation,” Brenda Auffinger, MD, and colleagues wrote in the study.
For the study, Auffinger and colleagues focused on 88 patients who underwent surgery for degenerative cervical spine disease from August 2009 to January 2012 and whose data were derived from a prospective spine outcome database.
According to the study, patients completed four PRO questionnaires preoperatively and at 3 months post-surgery and 6 months post-surgery, as well.
The study used two previously reported anchors and an independent anchor for derivations of MCID. The two reported anchors were HTI and patient overall status, the researchers noted. The independent anchor was surgeon ratings.
“Among the three anchors evaluated, ‘surgeon ratings’ consistently yielded the biggest area under the ROC curve (AUC),” Auffinger and colleagues wrote.
The MDC [mean change, change difference] approach was shown to be the best approach for MCID calculation, Auffinger and colleagues concluded.
“MDC together with the surgeon ratings anchor appears to be the most appropriate MCID method. This combination offers the greatest AUC (threshold above the 95% CI), and the choice of the anchor did not significantly affect this result,” they wrote.
Disclosure: Funding was received from the Spine Education and Research Fund at The University of Chicago. The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
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Auffinger B. J Neurosurg. 2014. DOI: 10.1227/NEU.0000000000000247