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Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine

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Abstract

Purpose

Health-related quality of life (HRQL) instruments are essential in value-driven health care, but patients often have more specific, personal priorities when seeking surgical care. The Scoliosis Research Society-22R (SRS-22R), an HRQL instrument for spinal deformity, provides summary scores spanning several health domains, but these may be difficult for patients to utilize in planning their specific care goals. Our objective was to create preoperative predictive models for responses to individual SRS-22R questions at 1 and 2 years after adult spinal deformity (ASD) surgery to facilitate precision surgical care.

Methods

Two prospective observational cohorts were queried for ASD patients with SRS-22R data at baseline and 1 and 2 years after surgery. In total, 150 covariates were used in training machine learning models, including demographics, surgical data and perioperative complications. Validation was accomplished via an 80%/20% data split for training and testing, respectively. Goodness of fit was measured using area under receiver operating characteristic (AUROC) curves.

Results

In total, 561 patients met inclusion criteria. The AUROC ranged from 56.5 to 86.9%, reflecting successful fits for most questions. SRS-22R questions regarding pain, disability and social and labor function were the most accurately predicted. Models were less sensitive to questions regarding general satisfaction, depression/anxiety and appearance.

Conclusions

To the best of our knowledge, this is the first study to explicitly model the prediction of individual answers to the SRS-22R questionnaire at 1 and 2 years after deformity surgery. The ability to predict individual question responses may prove useful in preoperative counseling in the age of individualized medicine.

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Funding

The International Spine Study Group Foundation receives funding support from DePuy Synthes, K2M, NuVasive, Orthofix and Zimmer Biomet. The European Spine Study Group receives funding support from DePuy Synthes and Medtronic. Additional support was provided through Project PI16/01283, funded by Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF).

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Correspondence to Miquel Serra-Burriel.

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Conflict of interest

Dr. Ames reports personal fees from DePuy Synthes, personal fees from Stryker, personal fees from Biomet Spine, personal fees from NuVasive, personal fees from Next Orthosurgical, personal fees from DePuy Synthes, personal fees from Medtronic, personal fees from Stryker, personal fees from Medicrea, personal fees from K2M, personal fees from UCSF, outside the submitted work. Dr. Smith reports grants from DePuy Synthes/ISSG, during the conduct of the study; personal fees from Zimmer Biomet, personal fees from NuVasive, personal fees from K2M, personal fees from AlloSource, from Cerapedics, grants from NREF, grants from AOSpine, from DePuy Synthes/ISSG, outside the submitted work. Dr. Pellisé reports grants from DePuy Synthes Spine, grants from Fondo de Investigaciones Sanitarias, during the conduct of the study; personal fees from DePuy Synthes Spine, grants from Medtronic, grants from Zimmer Biomet, outside the submitted work. Dr. Kelly reports grants from AOSpine, grants from DePuy Synthes, grants from DePuy Synthes, outside the submitted work. Dr. Gum reports grants from DePuy Synthes Spine, personal fees from Acuity, personal fees from Alphatec Spine, personal fees from DePuy Synthes, personal fees from K2M, personal fees from Medtronic, personal fees from NuVasive, personal fees from Stryker Spine, outside the submitted work. Dr. Alanay reports grants from DePuy Synthes, during the conduct of the study; grants from DePuy Synthes, grants from outside the submitted work. Dr. Acaroglu reports grants from DePuy Synthes, during the conduct of the study; grants from Medtronic, personal fees from AOSpine, outside the submitted work. Dr. Sánchez Pérez-Grueso reports grants and other from DePuy Synthes, other from K2M, outside the submitted work. Dr. Kleinstueck reports grants from DePuy Synthes, during the conduct of the study. Dr. Obeid reports grants from DePuy Synthes, during the conduct of the study; personal fees from DePuy Synthes, personal fees from Medtronic, personal fees from Alphatecspine, personal fees from Spineart, personal fees from Clariance, outside the submitted work. Dr. Vila-Casademunt has nothing to disclose. Mr. Shaffrey has nothing to disclose. Dr. Burton reports grants, personal fees and other from DePuy Spine, non-financial support from International Spine Study Group, non-financial support from Scoliosis Research Society, non-financial support from University of Kansas Physicians, other from Bioventus, other from Pfizer, outside the submitted work. Dr. Lafage reports grants from SRS, NASS, grants from DePuy Spine, grants from NuVasive, grants from Stryker, grants from K2M, personal fees from DePuy Spine, personal fees from AO Spine, personal fees from K2M, outside the submitted work. Dr. Schwab reports grants from DePuy Spine, grants from Stryker, grants from K2M, grants from NuVasive, personal fees from Medicrea, personal fees from Zimmer Biomet, personal fees from NuVasive, personal fees from K2M, personal fees from MSD, other from Nemaris INC, outside the submitted work. Dr. Shaffrey reports grants from ISSG Foundation, during the conduct of the study; personal fees from Medtronic, personal fees from NuVasive, personal fees from Zimmer Biomet, outside the submitted work. Dr. Bess reports grants from DePuy Synthes Spine, grants from K2 Medical, during the conduct of the study; grants from NuVasive, grants from Medtronic, grants from Stryker Spine, grants from Biomet Spine, grants from Orthofix, personal fees from K2 Medical, outside the submitted work. Dr. Serra-Burriel has nothing to disclose.

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Supplementary material 1 (PPTX 243 kb)

586_2019_6079_MOESM2_ESM.tif

Graphical summary of the accuracy and kappa for five-class classification of each individual answer of the SRS-22R based on two assessed baseline time horizons, preoperatively and postoperatively: (A) baseline to 1 year and (B) baseline to 2 years. The upper panels represent the preoperative baseline models (i.e., models only include information available prior to surgery), and the lower panels represent the postoperative baseline models (i.e., models include information available up to the point of hospital discharge following surgery). Average estimates are presented as dots, and 95% confidence intervals are presented as delimiters (TIFF 765 kb)

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Supplementary material 4 (DOCX 41 kb)

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Ames, C.P., Smith, J.S., Pellisé, F. et al. Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine. Eur Spine J 28, 1998–2011 (2019). https://doi.org/10.1007/s00586-019-06079-x

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