Pain Interference Influence on Postoperative Clinical Trajectory in Patients Undergoing Lumbar Decompression

• Published in: World neurosurgery Vol. 169; pp. e270 - e278
• Main Authors: Nie, James W., Hartman, Timothy J., Oyetayo, Omolabake O., MacGregor, Keith R., Zheng, Eileen, Singh, Kern
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023
• Subjects: Decompression; Humans; Lumbar decompression; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; MCID; Pain; Pain - etiology; Patient Reported Outcome Measures; Postoperative Period; PROs; Spinal Fusion - adverse effects; Treatment Outcome; PROs; PROMIS-PI; PROMIS; PROMIS-PF; VAS; PROMIS-SD; POD0; Pain; Lumbar decompression; MCID; ODI; PROMIS-A; PI
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.10.122

Newer Patient-Reported Outcomes (PROs) may offer benefits over legacy PROs in ease of administration and interpretation. We aim to study the influence of preoperative pain interference (PI) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) on postoperative clinical outcomes in patients undergoing lumbar decompression.
Patients undergoing lumbar decompression without fusion were separated into 2 cohorts: PROMIS-PI < 64 (lesser PI) and PROMIS-PI ≥ 64 (greater PI). PROs included PROMIS physical function, PROMIS anxiety (PROMIS-A), PROMIS sleep disturbance (PROMIS-SD), PROMIS-PI, Patient Health Questionnaire-9, Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) and were collected at preoperative and postoperative time points. Demographics, perioperative characteristics, PROs, and Minimum Clinically Important Difference (MCID) were compared among groups through non-parametric inferential statistics.
One-hundred and seven patients were identified. Independent of preoperative PI, patients reported significant postoperative improvement in PROMIS physical function, PROMIS-A, PROMIS-PI, VAS back, VAS leg, and ODI. The greater PI cohort reported significant postoperative improvement in Patient Health Questionnaire-9 and PROMIS-SD. The lesser PI cohort reported superior preoperative PROs in all domains. Postoperatively, the lesser PI cohort reported superior 6-week PROMIS-A and PROMIS-SD. MCID achievement rates were higher in the greater PI cohort for PROMIS-PI, VAS back, VAS leg, and ODI.
Patients with lower preoperative PI reported superior postoperative anxiety and sleep disturbance. Patients with greater preoperative PI had higher MCID achievement rates in PI, pain, and disability. Patients with greater preoperative PI undergoing lumbar decompression may demonstrate higher rates of clinically tangible improvement.