Elsevier

Journal of Clinical Orthopaedics and Trauma

Volume 11, Issue 5, September–October 2020, Pages 910-915
Journal of Clinical Orthopaedics and Trauma

The influence of gender on postoperative PROMIS physical function outcomes following minimally invasive transforaminal lumbar interbody fusion

https://doi.org/10.1016/j.jcot.2020.04.007Get rights and content

Abstract

Purpose

Our aim is to examine the gender performance of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) scores among patients undergoing minimally invasive transforaminal lumbar fusion (MIS TLIF).

Methods

A prospectively collected surgical dataset was retrospectively assessed for eligible patients from March 2015–June 2019. We included patients if they underwent primary MIS TLIF procedures on one or two vertebral levels. We collected baseline demographics, perioperative characteristics, and PROMIS-PF scores for each subject at pre and postoperative timepoints (e.g., 6-weeks, 3-months, 6-months, and 1-year). Chi-squared analyses were utilized to assess categorical variables and a Student’s t-tests analyzed continuous variables. A linear regression was used to analyze PROMIS-PF scores from baseline through all postoperative time points. Finally, we evaluated the PROMIS PF achievement of minimal clinically important difference (MCID) among gender.

Results

192 patients were included: 77 were females and 115 were males. No significant differences were observed among gender subgroups for PROMIS-PF scores at pre- or postoperative evaluations. Compared to males, females experienced significantly greater postoperative improvement with PROMIS-PF scores at the 3-month assessments, though no significant gender differences were observed during later follow-up evaluations at 6-months or one year. Females were observed to have significant PROMIS-PF score improvement from their preoperative evaluation to each postoperative score. Males were assessed to have statistically significant postoperative (e.g., at 3-months, 6-months, and 1-year) PROMIS-PF score improvement from their preoperative PROMIS-PF scores. There were no significant differences among gender in achieving MCID at any postoperative time interval.

Conclusion

Among gender, we observed no statistically significant difference in PROMIS-PF scores during the pre- or postoperative evaluations. Additionally, with no difference in the rate of achieving PROMIS-PF MCID postoperatively, this study established that both genders should experience similar functional outcomes following MIS TLIF.

Introduction

The Patient-Reported Outcome Measurement Information System (PROMIS) is becoming widely implemented to evaluate patient health status and wellbeing in a variety of surgical and nonsurgical settings.1,2 The National Institutes of Health (NIH) initially created the PROMIS set of instruments based Computer Adaptive Testing (CAT) as well as item response theory. The goal of PROMIS was to improve on previously developed patient reported outcome measures (PROM) by developing a time-effective survey that could be remotely administered for patients either at home or in clinic. The physical function (PF) and disability version of PROMIS can be used for patients independent of disease state.3,4 Compared to numerous earlier PROMs, PROMIS offers advantages due to its ability to gather a comprehensive patient health profile in a timely and efficient manner.

PROMIS instruments offer several domains that can be utilized to evaluate mental, physical or social patient health statuses. Nonetheless, the PROMIS PF domain is an important outcome measurement within spine surgery because of its validated assessment of coordination, mobility, and strength. While the PROMIS PF metric is validated for use in many clinical settings, there are still questions regarding its ability to evaluate outcomes within specific patient populations undergoing spine surgery operations.

Patient characteristics including age, insurance status, and diabetes status have previously been associated with poor postoperative outcomes. However, gender differences may also have implications on surgical recovery.5 Biological differences between men and women can have a significant influence on disease manifestation and treatment outcomes, especially within the realm of degenerative spinal conditions.6, 7, 8 Gender has previously been associated with differences in the development of spinal pathology as well as pain perception and functional impairment.10, 11, 12, 9 Thus, significant attention has been given to the study of gender-related influences of spinal conditions, with the goal of developing targeted prevention, diagnostic, and treatment strategies. We sought to evaluate pre- and postoperative PROMIS PF scores among gender in order to identify potential differences in lumbar fusion postoperative recovery. Our null hypothesis was that, among patients of both genders, there would be no difference between the mean pre- and postoperative PROMIS scores of either gender.

Gender differences have been evaluated by other researchers as a potential contributing factor for adverse patient events and worse patient survey scores following spinal surgeries, though we were unable to find any investigations that used the PROMIS PF instrument to evaluate possible differences in clinical outcomes among gender.10,13,14 Furthermore, to our knowledge, the vast majority of investigations that have assessed gender differences among lumbar spine surgery populations have found significant gender differences at final times of follow-up. Therefore, the goal of our investigation was to evaluate potential gender differences in postoperative recovery among patients undergoing minimally invasive transforaminal lumbar fusion (MIS TLIF). MIS TLIF is a common spine surgery that is typically used to treat conditions such as degenerative disc disease, spondylolisthesis, and recurrent disc herniation. The aim of our study is to identify possible gender differences in pre- and postoperative outcomes following MIS TLIF through an analysis of PROMIS PF instrument scores.

Section snippets

Study population

We conducted this study after obtaining approval from our Institutional Review Board (ORA# 14051301). A prospectively collected surgical registry of patient records was assessed for eligible patients from March 2015 to June 2019. Eligible patients were those who received a primary, one- or two-vertebral level MIS TLIF procedure for degenerative spinal pathology. Patients were removed from this study if they had incomplete preoperative PROMIS PF evaluations. All spine surgeries in this study

Results

After selection, 192 MIS TLIF patients were included in our study. 77 (40.1%) patients were females and 115 (59.9%) were male. Evaluation of baseline demographics and spinal pathologies revealed no statistically significant differences among gender (Table 1). We observed no statistically significant difference among gender when assessing perioperative variables such as day of discharge, EBL, hospital length of stay, operative time duration, or number of involved operative levels (Table 2). The

Discussion

Since its recent introduction, PROMIS PF has been used to assess health status among patients who have undergone elective spine surgery with regard to their mobility, coordination, and physical strength. PROMIS PF can be utilized in a wide range of spinal conditions and procedures to efficiently measure the preoperative and postoperative outcomes that can be potentially influenced by various factors. Previous studies have demonstrated that, among patients undergoing elective spine surgery for

Conclusion

We evaluated gender differences by utilizing the PROMIS PF score system among patients who had undergone MIS TLIF procedures. Whether evaluated during the pre- or postoperative time periods, patients of different genders demonstrated no statistically significant difference in PROMIS PF scores. Additionally, patients of either gender achieved MCID for PROMIS PF scores at a similar rate. This study established that both genders might expect a similar recovery in physical functionality following

Declaration of competing interest

No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

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