Comparison Between Short-Term and 1-Year Patient-Reported Outcome Measures After Anterior Cervical Discectomy and Fusion.

Abstract

Retrospective study of adult patients who underwent 1-4 level primary elective ACDF at a tertiary care center (2014-2022). This study's purpose was to evaluate the timing of patient-reported outcome measure (PROM) changes up to a year after anterior cervical discectomy and fusion (ACDF) and to identify any plateaus in improvement within this time period. The goal was to provide information for patients/providers and minimize unnecessary extended PROM collection. ACDF is a largely successful procedure, but there is minimal literature evaluating the optimal time frame for PROM collection after ACDF, despite increasing emphasis on PROMs to evaluate outcomes and determine reimbursement. Demographics, including age, sex, BMI, insurance, and distressed community index, were collected. Outcomes included 30- and 90-day readmissions, revisions, and PROMs (preoperative and at 3, 6, and 12 months postoperative). PROMs included modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) Neck/Arm, Physical Component Summary (PCS-12), and Mental Component Summary (MCS-12) scores. The percentage of patients achieving minimum clinically important differences (MCID) was calculated for VAS Neck/Arm and mJOA. Seven hundred sixty-eight patients (49.1% female, mean age: 56.5 y) underwent ACDF (49% 1-2-level, 23.3% 3-level, and 6.77% 4-level). Ninety-day readmission and 1-year revision rates were 0.91% and 3.52%, respectively. Across all PROMs, patients improved significantly from baseline to 3 months (P<0.001). However, no differences were noted across PROMs in the 3-6 and 6-12 months intervals postoperatively. Pairwise comparison of MCID achievement between the different postoperative timepoints showed no differences after 3 months. This study showed that PROM values and the likelihood of MCID achievement plateau 3 months after ACDF, challenging the necessity of PROM follow-up up to a year. Reassessing the utility of long-term PROM collection may lead to more inclusive and cost-efficient investigations in spine surgery outcomes, without compromising data quality.