Titus M, Tarawneh O, Ortiz S, Ponna A, Schroeder G, Canseco J, Hilibrand A, Narayanan R, Vaccaro A, Kepler C
Rothman Orthopaedic Institution, Philadelphia, PA, United states

Introduction
In the context of spinal care, few studies have examined barriers to Patient Reported Outcome Measures (PROM) completion, and none have assessed completion in the cervical spine population (1, 2). We aimed to examine both patient specific barriers to PROM completion. Recognizing and understanding these barriers is valuable for surgeons in identifying patients who may benefit from closer follow-up to ensure comprehensive assessment of surgical outcomes.

Methods
A retrospective cohort study was conducted of adult patients who underwent anterior
cervical discectomy and fusion(ACDF) between 2014- 2022 at a single tertiary academic
institution. Inclusion criteria included patients who underwent a primary or revision ACDF and
had either incomplete or complete PROMs at 1 year. Patient demographics and surgical
characteristics were collected. Bivariate analysis was performed to assess variables associated
with failure to complete PROMs. Multivariate logistic regression was then used to control for
potential confounding factors.

Results
A total of 2,961 patients were included, of which 1,776 (59.9%) had incomplete PROMs
and 1,185(40.1%) had complete PROMs. On logistic regression each additional year of age was
associated with a statistically significant decrease in the likelihood of incomplete PROMs (OR =
0.96, P < 0.001). Charlson Comorbidity Index (CCI) showed a strong positive association with
PROM non-completion. Each point increase in CCI was associated with more than double the
odds of PROM non-completion (OR = 2.11, 95% Cl: 1.88-2.38, P < 0.001). Current smokers had higher, albeit marginally non-significant, odds of failing to complete PROMs when compared to non-smokers (OR = 1.45, 95% Cl: 0.98-2.23, P = 0.056). Being married was associated with a lower likelihood of incomplete PROMs (OR = 0.67, P = 0.012). Moreover, workers’ compensation patients had significantly higher odds of failing to complete PROMs compared to those with private insurance (OR = 8.29, 95% Cl: 2.23-40.48, P = 0.003). There was no statistically significant difference in the odds of PROM non-completion between Medicare beneficiaries and those with private insurance (OR = 0.67, 95% Cl: 0.41-1.06, P = 0.095).

Conclusions
Failure to complete PROMs is a multifaceted and complex issue. Our findings highlight the significant role that patient specific factors play in capturing long term PROMs. Age, marital status, comorbidity burden, and insurance type, play a significant role in the failure to complete PROMs. Robust strategies aimed at improving PROM completion are needed. Surgeons should recognize the unique patient characteristics associated with failure to complete PROMs in order to enhance postoperative care strategies and patient engagement in follow-up care.

Refs:
1. Cruz Rivera S. et al., JAMA 2022
2. Falavigna A. et al., World Neurosurg 2017