Evaluation of the Association Between Preoperative Patient-Reported Outcomes And Functional Improvement Following LRTI
Damian A. Illing, MD, MS1; Beatrice Grasu, MD1; Nicholas B Henrie, BS1; Zhining Ou, PhD1; Angela Presson, PhD2; Andrew R Tyser, MD3; Nikolas H Kazmers, MD MSE1
1University of Utah, Salt Lake City, UT, 2Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, 3Department of Orthopaedics, University of Utah, Salt Lake City, UT
Introduction: The utility of preoperative patient-reported outcomes (PROs) as prognostic variables for functional improvement following hand surgical procedures is unclear. We hypothesized that high levels of preoperative pain interference, depression, and anxiety are associated with lower magnitudes of functional improvement following LRTI.
Materials & Methods: Adult (?18yr) patients who received an LRTI by fellowship-trained orthopaedic hand surgeons between December 2014 and February 2018 at an academic tertiary institution were considered for inclusion in this retrospective study. Simultaneous carpal tunnel release (CTR), proximal trapezoid excision, and metacarpophalangeal procedures were not grounds for exclusion; however patients undergoing other procedures were excluded. PROs were prospectively collected by tablet computer, including the QuickDASH, PROMIS Pain Interference (PI) Computer Adaptive Test (CAT), PROMIS Depression CAT, and PROMIS Anxiety CAT. Preoperative PROs (?90 days preoperatively) and follow-up PROs (6-26 weeks postoperatively) were required for inclusion. Univariate and multivariable linear regression analyses were performed to identify factors associated with the magnitude of improvement on the QuickDASH.
Results: Mean age was 62.7 ± 7.2 years and 74% were female (n = 119). Preoperative PROMIS PI, Depression, and Anxiety CAT scores were 60.6 ± 6.1, 47.9 ± 8.3, and 51.8 ± 8.7, respectively. At a mean of 12.2 weeks postoperatively, the mean change in the QuickDASH was -10.1 ± 19.6. QuickDASH improvement was -16.1 ± 20.7 for those with a PROMIS PI CAT above the median, versus -4.1 ± 16.5 if less than the median (p < 0.001). In the multivariable model, a higher preoperative PROMIS PI score was associated with greater improvement on the QuickDASH (coefficient -1.45, meaning the QuickDASH decreased 1.45 points for every 1 additional PI CAT point; p < 0.001), as was the PROMIS Anxiety CAT (coefficient -0.71; p = 0.34) but not the Depression CAT (p = 0.12), while controlling for age, sex, race, alcohol and tobacco use, preoperative narcotic use, prior treatments, presence of additional preoperative diagnoses, Eaton stage, provider, anesthesia type, and whether an MP procedure, proximal trapezoid excision, or CTR was performed.
Conclusions: Our main finding was that higher preoperative pain interference, or the extent to which pain interferes with one's life, was associated with greater functional improvement in the early postoperative period following LRTI. This suggests that the PROMIS PI CAT may be useful when identifying patients who may benefit the most from LRTI, and challenges the concept that the PROMIS PI CAT unidimensionally measures resilience or coping skills.
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