Patient Reported Outcomes in Patients Who Stop Following Up: Are They Doing Better or Worse Than the Patients That Come Back?. Issue 20 (15th October 2020)

• Record Type: Journal Article
• Authors: Chen, Darren A.; Vaishnav, Avani S.; Louie, Philip K.; Gang, Catherine Himo; McAnany, Steven J.; Iyer, Sravisht; Albert, Todd J.; Qureshi, Sheeraz A.
• Is Part Of: Spine. Volume 45:Issue 20(2020)
• Publication Date: 2020-10-15
• Subjects: activities -- back -- decompression -- driving -- follow-up -- fusion -- lost -- lumbar -- MIS -- PROMs -- spine; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003543
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Follow-up study. Objective: To determine whether minimally invasive lumbar spine surgery outcomes are different between those who are lost to follow-up and those who are not. Summary of Background Data: Lost to follow-up patients are a common source of selection bias for clinical outcomes research. Currently, there are no US based studies that evaluate the differences in outcomes of lost to follow-up patients after spine surgeries. Methods: A retrospective review of prospectively collected data of 289 patients who underwent minimally invasive lumbar surgery and were at least 1 year postsurgery was performed. Patients were divided into two groups: (1) lost to follow-up (LTF), defined as patients who had missed more than two consecutive follow-up visits and had not attended their 1-year follow-up appointment; and (2) not lost to follow-up. For the not-LTF cohort, patient response outcome measures (PROMs) (oswestry disability index (ODI), visual analog scale (VAS) back/leg, Short Form-12 (SF-12) Physical/Mental, PROMIS) and return to activities data were collected prospectively at each follow-up. For LTF patients, data were collected through emailed surveys or telephone interviews. PROMs and return to activities data of the two groups were compared. Sub-group analysis by type of surgery (decompression or fusion) was also performed. Results: For the entire cohort, independent t test analysis showed LTF patients had greater improvement in PROMIS Physical Function scores than those who were not-LTF (15.08 vs. 10.38, P = 0.026). For fusion surgeries, LTF patients showed a greater improvement in ODI (–30.94 vs. –16.23, P = 0.003) VAS back (–4.92 vs. –2.99, P = 0.044), and PROMIS-PF (16.09 vs. 10.38, P = 0.049). There were no significant differences in complication rates between LTF and not LTF patients. Conclusion: Patients undergoing minimally invasive lumbar surgery—in particular lumbar fusions—who are lost to follow-up and responded to subsequent email and phone interviews showed greater improvements in self-reported outcomes than those who continued to follow-up. Thus, our results suggest that a substantial subset of patients who are lost to follow-up do not fare worse than those who do follow-up. However, an opposite response cannot be excluded in those who did not respond to email and phone interviews. Level of Evidence: 3