Background

Patient-reported outcome measures (PROMs) are increasingly used to assess patients’ perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear.

Objective

To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients.

Methods

Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score>-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes.

Results

A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5+10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p<0.001), nonroutine discharge (73.9% vs 31.3%, p<0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020).

Conclusion

The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.

中文翻译：

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术前患者报告的身体健康相关生活质量可预测脑肿瘤患者的短期术后结果

背景

患者报告的结果测量（PROM）越来越多地用于评估患者的围手术期健康状况。PROM 信息系统 29 (PROMIS-29) 是一种经过充分验证的用于患者身体健康的全球健康评估工具，但其在颅神经外科中的效用尚不清楚。

客观的

探讨术前 PROMIS-29 身体健康 (PH) 汇总评分在预测脑肿瘤患者术后结果中的效用。

方法

确定了在单一机构（2018 年 1 月至 2021 年 12 月）接受切除术的成年脑肿瘤患者，并在术前访视期间前瞻性地接受了 PROMIS-29 调查。构建 PH 汇总评分，并通过查找相关接受者操作特征曲线的约登指数来近似住院时间 (LOS)、出院处置 (DD) 和 30 天再入院的最佳预测阈值。根据基线特征，使用双变量分析来研究低（z 得分≤-1）与高（z 得分>-1）PH 得分的分布。Logistic 回归模型量化了术前 PH 总结评分与术后结果之间的关联。

结果

总共确定了 157 名脑肿瘤患者（平均年龄 55.4 ± 15.4 岁；58.0% 女性；平均 PH 评分 45.5+10.5）。结果包括住院时间延长（24.8%）、非常规出院处置（37.6%）和 30 天再入院（19.1%）。在双变量分析中，PH 评分较低的患者被诊断为高级别肿瘤的可能性显着更高（69.6% vs 38.85%，p=0.010），并且进行择期手术的可能性较小（34.8% vs 70.9%，p=0.002） ）。低 PH 评分与 LOS 延长（26.1% vs 22%，p<0.001）、非常规出院（73.9% vs 31.3%，p<0.001）和 30 天再入院（43.5% vs 14.9%，p=0.003）相关。在多变量分析中，低 PH 评分预示着更高的 LOS（比值比 [OR]=6.09，p=0.003）、非常规出院（OR=4.25，p=0.020）和 30 天再入院（OR=3.93，p=0.020） 。

结论

PROMIS-29 PH 总结评分可预测脑肿瘤患者的短期术后结果，并可纳入前瞻性临床工作流程中。