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Spine registries display most accurate outcomes at 1 year postoperatively

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WASHINGTON — Results of a prospective, longitudinal study showed, despite a correlation between certain outcome measures at the 3-month and 12-month postoperative time points, there was a discrepancy between the minimum clinical important difference later on. This discrepancy was sizable enough to lead the researchers to recommend a minimum follow-up period of 12 months.

Matthew J. McGirt, MD, FAANS, presented findings from the study, which included 593 patients who underwent lumbar spine surgery at a single institution, at the American Association of Neurological Surgeons Annual Meeting, here.

Patients were enrolled in a registry that contained prospectively recorded patient-reported outcomes at baseline, 3 months and 12 months. McGirt said about 12% of patients lost their clinical improvement between the two time points that he and colleagues studied. However, 11% went on to gain clinical improvement during that same time, he said.

A receiver operating characteristic curve analysis was performed to determine whether improvement in general health state, based on the EuroQol- 5D (EQ-5D), and disability, based on Oswestry Disability Index (ODI) results, at 3 months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months.

According to the results, for ODI, achieving MCID at 3 months accurately predicted the 12-month MCID; however, specificity was only 62.6%, and sensitivity was only 86.8%. For postoperative EQ-5D outcomes, 8.5% of patients lost MCID threshold improvement between 3 months and 12 months postoperatively, whereas 4% of patients gained in MCID threshold during the same time period.

The EQ-5D, or quality-adjusted life years, showed achieved MCID at 3 months accurately predicted 12-month MCID, but with only 87.7% specificity and 87.2% sensitivity, according to the researchers.

McGirt noted that unless registries include patient-based outcomes for lumbar surgery at least through 12 months, investigators and clinicians will not know how well their patients are truly recovering.

“Registry science is here to stay across all fields of medicine. I think we have an opportunity to lead this. We are the content experts in neurosurgery and spine surgical care. We have to be at the forefront,” McGirt said. “As we do this ... it is pretty clear early on, at least in this study that we are going to need to stay connected to patients and measure their response to the care we provide after spine surgery for at least 1 year.” – by Susan M. Rapp

• Reference:
• McGirt MJ, et al. Paper #601. Presented at: American Association of Neurological Surgeons Annual Meeting; May 2-6, 2015; Washington, D.C.

• For more information:
• Matthew J. McGirt, MD, can be reached at Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204; email: matt.mcgirt@cnsa.com.

Disclosure: McGirt reports no relevant financial disclosures.