P108. Self-image is Underestimated As a Primary Driver for Patient Treatment and Surgical Satisfaction in Adult Spinal Deformity (ASD)

BACKGROUND CONTEXT Pre- and postoperative ASD assessment has primarily focused on pain and physical function. Patient self-image is an established important outcome measure for pediatric spine deformity, however little data exists regarding the impact that patient reported self-image has on patient treatment decision making and postoperative patient satisfaction. PURPOSE Evaluate the impact that preoperative patient self-image has upon selection for operative vs nonoperative ASD treatment and evaluate the association of postoperative self-image with patient satisfaction with surgical treatment. STUDY DESIGN/SETTING Prospective, multi-center analysis. PATIENT SAMPLE ASD patients enrolled into a prospective multi-center study. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), Oswestry Disability Index (ODI), Short-Form Health Questionnaire-36 (SF-36), EuroQol 5D (EQ-5D). METHODS Factor analysis and decision tree modeling was performed on operative and nonoperative treated ASD patients prospectively enrolled into a multi-center study from 2009-2020. Data elements from physical examination, demographics, past medical history, radiographic spinal alignment, and individual questions from SRS-22r, ODI, SF-36, EQ5D, and NRS pain were evaluated for the specific variables that 1) most correlated with patients electing for surgical treatment and 2) most correlated with patient surgical satisfaction at minimum 2-year followup. RESULTS A total of 1434 ASD patients (mean age 57.2 years, mean scoliosis 40.3 degrees, mean SVA 55.9mm) were enrolled into the study, 1086 elected for operative treatment, 348 elected nonoperative treatment. Factor analysis of over 2000 collected preoperative patient specific data elements, identified 23 discrete data variables that most strongly associated with ASD patients choosing surgical treatment (decision tree model ROC for training data=0.93, ROC for validation data=0.83). Patient self-image (SRS-22r question 4) was the single variable most strongly associated with patients choosing surgical treatment, accounting for 36% of the decision tree model (p<0.05). Comparatively, the next strongest preoperative variables associated with election for surgical treatment were 1) pain with standing and 2) NRS back pain, accounting for only 9.6% and 6.9% of the decision tree model, respectively. Postoperative factor analysis of patient satisfaction with surgical treatment again demonstrated patient self-image (SRS-22r question 4) was the single variable most strongly associated satisfaction with surgical treatment (p<0.05), accounting for 34% of the decision tree model (decision tree model ROC for training data=0.93, ROC for validation data=0.73). The next strongest postoperative variables associated with surgical satisfaction included 1) pain with personal care and 2) maximal scoliosis, accounting for only 14% and 5.2% of the decision tree model, respectively. CONCLUSIONS Pre- and postoperative factor analysis demonstrated that patient self-image is the strongest driver for ASD patients pursuing surgical treatment and is the single variable most associated with patient surgical satisfaction. Pain, mental health and physical function are important measures to assess ASD, however patient self-image is a critical measure that must be assessed for ASD. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Pre- and postoperative ASD assessment has primarily focused on pain and physical function. Patient self-image is an established important outcome measure for pediatric spine deformity, however little data exists regarding the impact that patient reported self-image has on patient treatment decision making and postoperative patient satisfaction. Evaluate the impact that preoperative patient self-image has upon selection for operative vs nonoperative ASD treatment and evaluate the association of postoperative self-image with patient satisfaction with surgical treatment. Prospective, multi-center analysis. ASD patients enrolled into a prospective multi-center study. Scoliosis Research Society-22r questionnaire (SRS-22r), Oswestry Disability Index (ODI), Short-Form Health Questionnaire-36 (SF-36), EuroQol 5D (EQ-5D). Factor analysis and decision tree modeling was performed on operative and nonoperative treated ASD patients prospectively enrolled into a multi-center study from 2009-2020. Data elements from physical examination, demographics, past medical history, radiographic spinal alignment, and individual questions from SRS-22r, ODI, SF-36, EQ5D, and NRS pain were evaluated for the specific variables that 1) most correlated with patients electing for surgical treatment and 2) most correlated with patient surgical satisfaction at minimum 2-year followup. A total of 1434 ASD patients (mean age 57.2 years, mean scoliosis 40.3 degrees, mean SVA 55.9mm) were enrolled into the study, 1086 elected for operative treatment, 348 elected nonoperative treatment. Factor analysis of over 2000 collected preoperative patient specific data elements, identified 23 discrete data variables that most strongly associated with ASD patients choosing surgical treatment (decision tree model ROC for training data=0.93, ROC for validation data=0.83). Patient self-image (SRS-22r question 4) was the single variable most strongly associated with patients choosing surgical treatment, accounting for 36% of the decision tree model (p<0.05). Comparatively, the next strongest preoperative variables associated with election for surgical treatment were 1) pain with standing and 2) NRS back pain, accounting for only 9.6% and 6.9% of the decision tree model, respectively. Postoperative factor analysis of patient satisfaction with surgical treatment again demonstrated patient self-image (SRS-22r question 4) was the single variable most strongly associated satisfaction with surgical treatment (p<0.05), accounting for 34% of the decision tree model (decision tree model ROC for training data=0.93, ROC for validation data=0.73). The next strongest postoperative variables associated with surgical satisfaction included 1) pain with personal care and 2) maximal scoliosis, accounting for only 14% and 5.2% of the decision tree model, respectively. Pre- and postoperative factor analysis demonstrated that patient self-image is the strongest driver for ASD patients pursuing surgical treatment and is the single variable most associated with patient surgical satisfaction. Pain, mental health and physical function are important measures to assess ASD, however patient self-image is a critical measure that must be assessed for ASD.