Are Preoperative PROMIS Scores Associated with Postoperative ED Visits?

Abstract

Category: Other Introduction/Purpose: Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been shown to be predictive of postoperative success in orthopedic foot and ankle patients. The purpose of this study was to determine if an association exists between pre-operative PROMIS scores and patients going to the emergency department (ED) in the first 60 days following their operation. Methods: PROMIS scores, including physical function (PF) and pain inference (PI), were collected from 290 patients prior to foot and ankle procedures. Patients with presence of ongoing infection were excluded. Electronic medical record (EMR) data was retrospectively gathered for each patient to determine if they visited the ED for any reason during the first 60 days following their operation. A Backward Stepwise Logistic Regression analysis was conducted for postoperative ED visits with p<0.1 in univariate analysis required for entry into the model. Results: The median age was 50.0 with an interquartile range (IQR) of 20.0, while the median BMI was 33.1 with an IQR of 11.6. In univariate analysis, Preoperative PROMIS PF and PI scores were significantly associated with ED visits within the first 60 days after surgery. Patients who visited the ED had lower preoperative PROMIS PF (median 34.9 (IQR 10.2)) and higher PROMIS PI (median 66.9 (IQR 9.1)) compared to patients who did not visit the ED, PROMIS PF (median 38.0 (IQR 10.2)) and PROMIS PI (63.6 (IQR 9.0)), respectively. In multivariate analysis, only PROMIS PF was associated with lower risk of ED visits OR 0.92 (95% CI.85-.99). Other factors independently associated with ED visits included non-traumatic surgical indication OR 3.7 (95% CI 1.1- 12.9), any pulmonary disease OR 4.2 (95% CI 1.4-12.8), ASA classification OR 4.4 (95% CI 1.3-14.9), and wound complications OR 10.2 (95% CI 2.6-39.9). Conclusion: Patients with lower PROMIS PF scores preoperatively were significantly more likely to visit the ED postoperatively. While all of the factors found to be associated with ED visits are not modifiable by the surgeon, preoperative PROMIS scores could quickly and easily be used to identify patients for potential interventions. This study demonstrates the potential of the PROMIS outcomes system outside of quantifying surgical outcomes. Further study is being conducted to investigate the optimal PROMIS PF cutoff for best identifying patients at risk for ED visits.