Key result
Evidence-based medicine guideline concordance for lumbar fusion increased the odds of achieving a minimal clinically important difference in ODI at 6 months (OR 3.04; 95% CI 1.10-8.40; P=.0322).
Why the study?
US healthcare is volume-based and inefficient, lacking quality consideration, prompting evaluation of whether meeting evidence-based medicine criteria preoperatively for lumbar fusion improves minimal clinical important difference achievement rates.
Does meeting evidence-based medicine guidelines for lumbar fusion improve the odds of achieving a minimal clinical important difference in functional outcomes?
Cohort (n=325)
Does meeting evidence-based medicine guidelines for lumbar fusion improve the odds of achieving a minimal clinical important difference in functional outcomes?
Odds Ratio: 3.04 (95% CI 1.1–8.4)
p-value: p=.0322
Adherence to evidence-based medicine guidelines for lumbar fusion significantly increases the odds of achieving a clinically meaningful improvement in functional outcomes.
BACKGROUND: United States (U.S.) healthcare is a volume-based inefficient delivery system. Value requires the consideration of quality, which is lacking in most healthcare disciplines. OBJECTIVE: To assess whether patients who met specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar fusion would achieve higher rates of achieving the minimal clinical important difference (MCID) than those who did not meet the EBM indications. METHODS: All elective lumbar fusion cases, March 2018 to August 2019, were prospectively evaluated and categorized based on EBM guidelines for surgical indications. The MCID was defined as a reduction of ≥5 points in Oswestry Disability Index (ODI). Multiple logistic regression identified multivariable-adjusted odds ratio of EBM concordance. RESULTS: A total of 325 lumbar fusion patients were entered with 6-mo follow-up data available for 309 patients (95%). The median preoperative ODI score was 24.4 with median 6-mo improvement of 7.0 points (P < .0001). Based on ODI scores, 79.6% (246/309) improved, 3.8% (12/309) had no change, and 16% (51/309) worsened. A total of 191 patients had ODI improvement reaching the MCID. 93.2% (288/309) cases were EBM concordant, while 6.7% (21/309) were not.In multivariate analysis, EBM concordance (P = .0338), lower preoperative ODI (P < .001), lower ASA (American Society of Anesthesiologists) (P = .0056), and primary surgeries (P = .0004) were significantly associated with improved functional outcome. EBM concordance conferred a 3.04 (95% CI 1.10-8.40) times greater odds of achieving MCID in ODI at 6 mo (P = .0322), adjusting for other factors. CONCLUSION: This analysis provides validation of EBM guideline criteria to establish optimal patient outcomes. The EBM concordant patients had a greater than 3 times improved outcome compared to those not meeting EBM fusion criteria.
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Harrop et al. (2021) conducted a cohort in Lumbar fusion (n=325). Evidence-based medicine (EBM) guideline concordance vs. Non-concordance with EBM indications was evaluated on Achieving the minimal clinical important difference (MCID) in Oswestry Disability Index (ODI) at 6 months (OR 3.04, 95% CI 1.10-8.40, p=.0322). Evidence-based medicine guideline concordance for lumbar fusion increased the odds of achieving a minimal clinically important difference in ODI at 6 months (OR 3.04; 95% CI 1.10-8.40; P=.0322).
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