The Impact of Comorbidity Burden on Postoperative PROMIS Physical Function Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

January 10, 2020

STUDY DESIGN:

This was a retrospective cohort study.

OBJECTIVE:

To assess the utility of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF) in assessing postoperative recovery on the basis of the comorbidity burden after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

SUMMARY OF BACKGROUND DATA:

Few studies have evaluated the effect of comorbidity burden in long-term clinical recovery after MIS TLIF.

METHODS:

Patients undergoing primary, 1-level to 2-level MIS TLIF were retrospectively reviewed and stratified on the basis of Charlson Comorbidity Index (CCI) score: 0 points (no comorbidities), 1-2 points (low CCI), ≥3 points (high CCI). CCI was tested for an association with demographic characteristics and perioperative variables using χ analysis and multivariate linear regression. Multivariate linear regression was utilized to determine the association between CCI cohorts and PROMIS PF.

RESULTS:

A total of 187 1-level and 2-level MIS TLIF patients were included: 53 had no comorbidities, 78 had a low CCI, and 56 a high CCI. One patient in the high CCI group experienced nonunion. Patients reported similar PROMIS PF scores preoperatively and up to 1-year postoperatively. Each cohort experienced a similar improvement in PROMIS PF scores from baseline at each postoperative time point. For patients without comorbidities, the change in the postoperative PROMIS PF score from baseline was significant at every postoperative time point. However, for the patients with ≥1 comorbidities, the change in the postoperative PROMIS PF score from baseline was significant at the 3-month, 6-month, and 1-year time points, however, the change from baseline to 6 weeks was not significant.

CONCLUSIONS:

In this investigation, the authors compared the clinical recovery of patients with varying comorbidities undergoing an MIS TLIF using PROMIS PF. Regardless of comorbidity, patients reported similar preoperative PROMIS PF scores and had similar improvements throughout the 1-year follow-up. This study established that PROMIS PF is an effective tool to evaluate the recovery of patients with differing comorbidities after MIS TLIF.