S206 ePosters / The Spine Journal 20 (2020) S181−S213
strategy, and postoperative complications were assessed. Comorbidity pro-
files were stratified by body systems (neurological, musculoskeletal, pul-
monary, cardiovascular, renal). Groups were compared using t-tests and
chi-squared tests for continuous and discrete variables, respectively. Multi-
variate logistic regressions were used to assess association between surgi-
cal characteristics/diagnosis with complication rate.
RESULTS: Included 90,707 spine pts, 63.3% Scol, 38.7%Ocm, and
2.0%Cms. Scol were older (13.6yrs vs CM: 5.9 vs Both:10.9) and had a
higher invasiveness score (2.4 vs OCm: 0.5 vs Both:1.5), while CmS pts
were more comorbid (0.9 vs OCm: 0.55 vs Scol: 0.89; all p<0.001). CmS
pts had higher rates of surgical decompression (25.4%) and Scol pts had
higher rates of fusions (35.3%) and osteotomies (1.2%; all p<0.001). How-
ever, CmS pts had the highest surgical rate (37.1% vs Scol: 36.6% vs
OCm:10.6%) among the cohort (p<0.001). Controlling for age and inva-
siveness, Scol pts receiving a fusion (1.8[1.08-3.2] operation were associ-
ated with development of postoperative complications as well as OCm
osteotomies (2.9[1.4-6.0]) and fusions (1.8[1.2-2.9]), and CmS fusion sur-
geries (1.8[1.0-3.2]; all p<0.05). Having a complication of acute respira-
tory distress (2.1[3.4-1.3]) and anemia (0.6[0.85-0.36]) were
independently associated with CmS operation (all p<0.05).
CONCLUSIONS: Having concurrent scoliosis and Chiari malformation
increases operative risk for when decompressive surgeries are performed.
Being independently inflicted with scoliosis or Chiari leads to increased
complication rate when paired with fusion surgeries.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or
include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2020.05.523
P126. Psychometric evaluation of PROMIS physical function
computer adaptive testing in minimally invasive lumbar spine
surgery: an analysis of responsiveness, coverage, discriminant validity
and concurrent validity
Avani S. Vaishnav, MBBS**, Steven J. McAnany, MD1, Sravisht Iyer,
MD2, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A.
Qureshi, MD, MBA2; 1 Hospital for Special Surgery, Stamford, CT, US;
2
Hospital for Special Surgery, New York, NY, US; ** Affiliation Not
Available
BACKGROUND CONTEXT: While ODI has historically been the most
commonly used patient-reported outcome measure for patients with lum-
bar spinal pathology, Patient-Reported Outcome Measurement Informa-
tion System (PROMIS) is increasingly being utilized. However, there are
few studies assessing the psychometric properties of PROMIS in mini-
mally invasive (MIS) spine surgery.
PURPOSE: To perform a psychometric evaluation of PROMIS Physical
Function Computer Adaptive Testing (PROMIS-PF CAT) in MIS lumbar
surgery.
STUDY DESIGN/SETTING: Retrospective review of prospectively col-
lected data.
PATIENT SAMPLE: A total of 421 patients who underwent MIS lumbar
surgery.
OUTCOME MEASURES: Patient-reported outcome measures [Oswes-
try disability Index − ODI, PROMIS-PF CAT, Short Form (SF)-12].
METHODS: Patient-reported outcome measure (PROMs) collected pre-
and post-operatively of patients undergoing MIS lumbar surgery were ret-
rospectively analyzed to assess responsiveness, coverage, discriminant
validity and concurrent validity of PROMIS-PF CAT. Responsiveness was
assessed using paired t-test, effect size (ES) and standardized response
mean (SRM). Coverage was measured by assessing floor and ceiling
effects. Discriminant validity was assessed pre- and post-op using indepen-
dent t-test to identify difference in PROMIS-PF scores in known groups.
Concurrent validity was assessed by evaluating the correlation with legacy
PROMs, ODI and SF12.
RESULTS: Responsiveness 1. Decompression cohort: SF-12 PHS and
PROMIS-PF have lower responsiveness than ODI in detecting an
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately
reporting disclosure and FDA device/drug status at time of abstract submission.
improvement at 2 weeks; PROMIS-PF also has lower responsiveness in
detecting improvement at 1 year. 2. Fusion cohort: ODI and PROMIS-PF
demonstrate equivalent responsiveness at all time-points; however, the
responsiveness of SF-12 is lower than that of ODI and PROMIS-PF at all
time-points. Coverage No floor effect was seen for any PROMs. ODI showed
a ceiling effect (% having the best possible score: 0.5% pre-operatively; grad-
ually increasing at 16.7% at 1-year). SF-12 PHS and PROMIS-PF did not
show a ceiling effect, and clustering at higher levels was <3%. Discriminant
validity 1. Preoperatively: PROMIS-PF showed known-groups validity
(p<0.0001), with post-hoc testing demonstrated that PROMIS-PF is able to
differentiate amongst all levels of ODI-defined disability. SF-12 PHS on the
other hand demonstrated known-groups validity for lower levels of disability
(p<0.0001), but was unable to differentiate at higher levels of disability. 2.
Postoperatively: Both SF-12 PHS and PROMIS-PF demonstrated discrimi-
nant validity in differentiating those with improvement greater than the
MCID from those with improvement less than the MCID on the ODI at all
time-points, except at 1 year. Convergent validity PROMIS-PF showed con-
vergent validity as demonstrated by the statistically significant strong nega-
tive correlation seen between ODI and PROMIS-PF at almost all time-
points, with a similar trend seen in each sub-group. SF-12 PHS and
PROMIS-PF also demonstrated a weak-to-moderate correlation pre-opera-
tively and a moderate-to-strong correlation in the postoperative period.
CONCLUSIONS: Although PROMIS-PF showed lower responsiveness
than ODI, particularly in the decompression sub-group, it demonstrated
discriminant validity pre- and post-operatively, convergent validity with
ODI and better coverage than ODI. These findings suggest that PROMIS-
PF CAT demonstrates reasonable psychometric properties and may be a
good surrogate for ODI.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or
include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2020.05.524
P127. PROMIS better reflects the impact of length of stay and the
occurrence of complications within 90 days than legacy outcome
measures for lumbar degenerative surgery
Sara Naessig, BS1, Cole Bortz, BA2, Katherine E. Pierce, BS3, Waleed
Ahmad2, Shaleen N. Vira, MD4, Bassel G. Diebo, MD5, Aaron J. Buckland,
MBBS, FRACS6, Peter G. Passias, MD7; 1 NYU Langone hospital, New
York, NY, US; 2 New York, NY, US; 3 NYU Spine Research Lab, New York,
NY, US; 4 Department of Orthopaedic Surgery, UT Southwestern Medical
Center, Dallas, TX, US; 5 Department of Orthopaedic Surgery, SUNY
Downstate Medical Center, Brooklyn, NY, US; 6 Department of
Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone
Health, New York, NY, US; 7 NY Spine Institute, NYU Langone Health,
New York, NY, US
BACKGROUND CONTEXT: The Patient Reported Outcome Measure-
ment Information System (PROMIS) aims to offer a valid, reliable and
efficient means of capturing spine surgery patient clinical outcomes. To
date, few studies have compared PROMIS and legacy outcome measures
like the Oswestry Disability Index (ODI) for their sensitivity in reflecting
the impact of perioperative complications and length of stay.
PURPOSE: Assess differences between PROMIS and ODI scores as they
relate to length of stay and complication outcomes of surgical thoracolum-
bar patients.
STUDY DESIGN/SETTING: Retrospective review of single institution
clinical data and patient-reported outcome measures.
PATIENT SAMPLE: A total of 182 patients undergoing thoracolumbar
surgery.
OUTCOME MEASURES: Length of stay (LOS), perioperative
complications.
METHODS: Patients >18 years undergoing thoracolumbar surgery with
available pre- and 3-month postoperative ODI and PROMIS scores were
included. Pearson bivariate correlation assessed the linear relationships
between clinical outcomes (including length of stay, complications) and