Preoperative patient-reported physical health-related quality of life predicts short-term postoperative outcomes in brain tumor patients

Sachiv Chakravarti, Cathleen C. Kuo, Foad Kazemi, Ashley Kang, Calixto Hope Lucas, Victoria Croog, David Kamson, Karisa Schreck, Matthias Holdhoff, Chetan Bettegowda, Debraj Mukherjee

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)477-485
Number of pages9
JournalJournal of neuro-oncology
Volume167
Issue number3
DOIs
StatePublished - May 2024

Keywords

  • Discharge disposition
  • Length of stay
  • PROMIS-29
  • Physical Health
  • Readmission, Brain tumors

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Oncology
  • Cancer Research

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