Abstract
BACKGROUND CONTEXT
Although incorporating patient reported outcomes (PROMs) into practice allows healthcare
systems to evaluate the value of care provided, research and policy reflecting PROMs
can only be valid if they represent all patients. Few studies have evaluated socioeconomic
barriers to PROM completion, and none have done so in a spine patient population.
PURPOSE
To identify patient barriers to PROM completion one year following lumbar spine fusion.
STUDY DESIGN/SETTING
Retrospective single-institution cohort study.
PATIENT SAMPLE
A total of 2,984 patients undergoing lumbar fusion between 2014 and 2020
OUTCOME MEASURES
Completion of Mental Component Score (MCS-12) and Physical Component Score (PCS-12)
of Short Form-12 questionnaire 1 year postoperatively
METHODS
A retrospective review was conducted of all patients undergoing 1-3-level lumbar fusion
at a single urban tertiary center. PROMs were queried from our prospectively managed
electronic outcomes database. Patients were considered to have complete PROMs if 1-year
outcomes were available. Community-level characteristics were collected from patients’
zip codes using the Economic Innovation Group Distressed Communities Index. Bivariate
analyses were performed to assess factors associated with PROM incompletion along
with multivariate logistic regression to control for confounders.
RESULTS
A total of 1,968 (66.0%) had incomplete 1-year PROMs. Patients with incomplete PROMs
were more likely to be Black (14.5% vs. 9.3%, p<.001), Hispanic (2.9% vs. 1.6%, p=.027),
reside in a distressed community (14.7% vs. 8.5%, p<.001), and be active smokers (22.4%
vs. 15.5%, p<.001). On multivariate regression, Black race (OR: 1.46, p=.014, Hispanic
ethnicity (OR: 2.19, p=.027), distressed community status (OR: 1.47, p=.024), workers’
compensation status (OR: 2.82, p=.001), and active smoking (OR:1.31, p=.034) all were
independently associated with PROM incompletion. Surgical characteristics, including
primary surgeon, revision status, approach, and levels fused were not associated with
PROM incompletion.
CONCLUSIONS
Social determinants of health impact completion of PROMs. Patients completing PROMs
are overwhelmingly White, non-Hispanic, and reside in wealthier communities. Efforts
should be taken to provide better education regarding PROMs and ensure closer follow-up
of certain subgroups of patients to avoid furthering disparities in PROM research.
Keywords
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Article info
Publication history
Published online: May 17, 2023
Accepted:
May 2,
2023
Received in revised form:
April 19,
2023
Received:
January 27,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: TZI: Nothing to disclose. YL: Nothing to disclose. GRT: Nothing to disclose. MJL: Nothing to disclose. AK: Nothing to disclose. DP: Nothing to disclose. JAC: Nothing to disclose. ASH: Royalties: Zimmer Biomet (F); CTL Medical Corporation (C). ARV: Royalties: Stryker (G), Globus (D), Medtronic (E), Atlas (D), Nuvasive (C), Alphatech Spine (B); Consulting: Spine Wave (B), Edwards Lifescience Corporation (B). GDS: Nothing to disclose. CKK: Nothing to disclose.
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