Tag: EQ-5D

Posted on

Using the Quality Outcomes Database to Identify Minimum Clinically Important Differences for Patients With Cervical Spondylotic Myelopathy

Neurosurgery 98:1347–1358, 2026

This multicenter retrospective analysis of 1,141 surgical cases from the Quality Outcomes Database defines optimal minimum clinically important differences (MCIDs) for commonly used patient-reported outcome measures (PROMs) in cervical spondylotic myelopathy (CSM). The study compares several MCID calculation methods using AUCs anchored to patient satisfaction at 3- and 24-month follow-ups to identify the most predictive thresholds.

Key findings report a ≥30% improvement from baseline as the preferred MCID for NDI and neck/arm NRS, severity-adjusted point increases for mJOA, and absolute numeric cutoffs for EQ-5D (0.065 at 3 months; 0.149 at 24 months). Achievement rates and implications for clinical decision-making and benchmarking across centers are provided.

Aim Identify the most appropriate MCID thresholds for common PROMs in surgical cervical spondylotic myelopathy (CSM) using the Quality Outcomes Database (QOD) cohort.

Cohort Analyze 1141 CSM surgical cases across 14 sites (enrolled 2016–2018) with a 24-month follow-up rate of 87.6% (excluding 2.5% deaths).

PROMs Use baseline, 3-month, and 24-month outcomes for NDI, EQ-5D (QALYs), mJOA, and neck/arm pain NRS, with patient satisfaction as the anchor.

Anchor/AUC method Define “satisfied” using the NASS satisfaction scale (responses 1–2) vs “not satisfied” (3–4), then compare MCID methods by AUC for predicting satisfaction.

NDI & pain MCID A ≥30% improvement from baseline is the preferred/optimal MCID benchmark for NDI and neck/arm pain NRS (close to the best-performing ROC-derived percentage cutoffs).

EQ-5D MCID Absolute numeric cutoffs outperform other methods for EQ-5D: +0.065 QALYs (3 months) and +0.149 QALYs (24 months).

mJOA MCID A severity-adjusted approach performs best for mJOA: improvement of ≥1 (mild), ≥2 (moderate), or ≥3 (severe) points.

MCID achievement (24 months) MCIDs are achieved by 63% (NDI), 59% (neck pain NRS), 61% (arm pain NRS), 52% (EQ-5D), and 59% (mJOA) of patients.

Posted on

How much do patients benefit in quality of life after surgery for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data

Neurosurg Focus 60(5):E2, 2026

This multicenter Quality Outcomes Database analysis evaluates long-term quality of life after surgery for cervical spondylotic myelopathy (CSM), using EQ-5D scores at baseline and 3, 12, 24, and 60 months. The study reports significant, durable postoperative EQ-5D improvements and a mean gain of 0.72 QALYs at five years across a large surgical cohort.

The analysis identifies predictors of clinically meaningful improvement: worse baseline EQ-5D increased odds of improvement, while greater baseline neck pain severity and undergoing anterior cervical corpectomy and fusion (ACCF) decreased those odds. Complication and mortality rates were low, supporting sustained quality-of-life benefits of CSM surgery.

Objective Assess long-term postoperative quality-of-life benefit after surgery for cervical spondylotic myelopathy (CSM) and identify factors linked to meaningful improvement.

Methods Post hoc analysis of a prospectively collected, 14-site QOD CSM cohort using EQ-5D at baseline and 3, 12, 24, and 60 months; MCID for EQ-5D defined as 0.11; multivariable logistic regression used to find predictors of 60-month MCID achievement.

Cohort At 60 months, follow-up status was available for 895/1085 patients (82.4%); 788 patients had 60-month EQ-5D data for the main EQ-5D analysis.

Quality-of-life gains Mean EQ-5D improved from 0.58 ± 0.22 preop to 0.76 ± 0.22 at 60 months (p < 0.001), with improvements evident by 3 months and sustained through 5 years.

Clinically meaningful benefit 58.7% of patients achieved the EQ-5D MCID at 60 months.

Negative predictors Greater baseline neck pain severity and undergoing ACCF (anterior cervical corpectomy and fusion) were independently associated with lower odds of achieving the 60-month EQ-5D MCID.

Positive predictor Worse baseline quality of life (lower baseline EQ-5D) was associated with increased odds of achieving long-term (60-month) MCID improvement.

QALYs Mean gain after surgery was 0.72 ± 1.11 QALYs over 60 months (calculated via area-under-the-curve with baseline-projected QALYs subtracted).

Posted on

Comparing posterior cervical foraminotomy with anterior cervical discectomy and fusion in radiculopathic patients: an analysis from the Quality Outcomes Database

J Neurosurg Spine 41:56–68, 2024

OBJECTIVE The objective of this study was to compare clinical and patient-reported outcomes (PROs) between posterior foraminotomy and anterior cervical discectomy and fusion (ACDF) in patients presenting with cervical radiculopathy.

METHODS The Quality Outcomes Database was queried for patients who had undergone ACDF or posterior foraminotomy for radiculopathy. To create two highly homogeneous groups, optimal individual matching was performed at a 5:1 ratio between the two groups on 29 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, underlying pathologies, and levels treated). Outcomes of interest were length of stay, reoperations, patient-reported satisfaction, increase in EQ-5D score, and decrease in Neck Disability Index (NDI) scores for arm and neck pain as long as 1 year after surgery. Noninferiority analysis of achieving patient satisfaction and minimal clinically important difference (MCID) in PROs was performed with an accepted risk difference of 5%.

RESULTS A total of 7805 eligible patients were identified: 216 of these underwent posterior foraminotomy and were matched to 1080 patients who underwent ACDF. The patients who underwent ACDF had more underlying pathologies, lower EQ-5D scores, and higher NDI and neck pain scores at baseline. Posterior foraminotomy was associated with shorter hospitalization (0.5 vs 0.9 days, p < 0.001). Reoperations within 12 months were significantly more common among the posterior foraminotomy group (4.2% vs 1.9%, p = 0.04). The two groups performed similarly in PROs, with posterior foraminotomy being noninferior to ACDF in achieving MCID in EQ-5D and neck pain scores but also having lower rates of maximal satisfaction at 12 months (North American Spine Society score of 1 achieved by 65.2% posterior foraminotomy patients vs 74.6% of ACDF patients, p = 0.02).

CONCLUSIONS The two procedures were found to be offered to different populations, with ACDF being selected for patients with more complicated pathologies and symptoms. After individual matching, posterior foraminotomy was associated with a higher reoperation risk within 1 year after surgery compared to ACDF (4.2% vs 1.9%). In terms of 12-month PROs, posterior foraminotomy was noninferior to ACDF in improving quality of life and neck pain. The two procedures also performed similarly in improving NDI scores and arm pain, but ACDF patients had higher maximal satisfaction rates.

Proudly powered by WordPress