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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Preoperative PROMIS Scores Allow for Better Postoperative Expectation Counseling Prior to Elective Hand Surgery
David N Bernstein, MBA, MA1; Jeff R Houck, PhD2; Danielle M Wilbur, MD1; Ronald M Gonzalez, DO1; Richard J Miller, MD1; Dave J Mitten, MD1; Warren C. Hammert, MD3; (1)University of Rochester Medical Center, Rochester, NY, (2)George Fox University, Newberg, OR, (3)Department of Orthopaedics, University of Rochester, Rochester, NY

Patients undergoing elective hand surgery often want to know what to expect during their postoperative recovery. Physicians face the challenge of being able to provide accurate expectations prior to surgery. A patient-reported outcomes instrument, such as PROMIS, may offer surgeons a better tool to help set patient expectations prior to surgical intervention. We sought to determine if preoperative PROMIS scores predict postoperative clinical improvement in patients undergoing elective hand surgery.

PROMIS scores for patient visits to a tertiary academic hand clinic between February 2015 and October 2016 were prospectively collected.  All patients undergoing elective hand surgery were identified using CPT and ICD-9, 10 codes. Only patients with initial and follow-up ( 6 months) data points were included. A total of 160 patients fit our inclusion criteria. The Minimum Clinically Important Differences (MCIDs) were calculated using a distribution-based model and set at one-half each PROMIS domains standard deviation. Receiver operating characteristic (ROC) curves were calculated to determine if preoperative PROMIS scores could predict a patient reaching or failing to reach the MCID. PROMIS Physical Function (PF), Pain Interference (PI) and Depression cut-off values were determined for reaching or failing to reach MCID with mid-90% specificity or sensitivity, respectively. Using our MCID cut-off values, prognostic pre- and posttest probabilities were then calculated.

ROC curves demonstrated moderate predictability from preoperative to postoperative PROMIS scores in PF (Area Under the Curve [AUC] = 0.74, p<0.001). ROC curves demonstrated fair predictability for PI (AUC = 0.69, p<0.001) and Depression (AUC = 0.66, p = 0.001).  Patients with a PF score < 32.0 had a 55% chance of reaching MCID, while patients with a PF score > 53.1 had a 27% probability of failing to reach MCID.  Patients with a PI score > 67.5 had a 78% chance of reaching MCID, while patients with a PI score < 49.5 had a 46% probability of failing to reach MCID. Patients with a Depression score > 62.2 had a 71% chance of reaching MCID, while patients with a Depression score < 39.5 had a 48% probability of failing to reach MCID.

PROMIS scores gathered from patients prior to elective hand surgery can assist hand surgeons when counseling patients on postoperative expectations. This can improve patient care through enhanced shared decision-making between surgeons and setting expectations following elective hand surgery.

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