Introduction: Patient-Reported Outcomes (PROs) are a well-established and clinically informative metric in spine surgery to evaluate preoperative patient expectations and postoperative outcomes. However, determinants of compliance of completed postoperative PROs in lumbar spine patients are largely unknown. Therefore, the study aimed to identify patient and operative factors associated with increased postoperative compliance of PROs following lumbar spine surgery. 

Methods: A retrospective study of prospectively collected data of 1,680 consecutive adult patients who underwent elective lumbar surgery at a single institution from 2017-2020 was performed. Serial confidential digital surveys were used to assess PROs and patient compliance, defined as the percentage of surveys completed at 3 time-points: preoperative, 3-months and 1-year after surgery. Multivariate logistic regression was used to assess the association of PRO compliance and patient characteristics.

Results: 1,680 patients (53.1% male, mean age: 57.7 years) were included for analysis. Mean PRO compliance was 64.7%. Compliance decreased continuously from initial pre-operative rates (84.5%) to lower rates at 3-month (54.4%) and 12-month (45.6%), respectively, with 33.2% of patients completing zero surveys at 12-month postoperatively. Factors associated with significantly increased PRO compliance included being employed (pre-op: OR=2.58, p=0.002; 3-month post-op: OR=1.25, p=0.095; 12-month post-op: OR=1.34, p=0.028). Factors associated with decreased compliance included pre-operative smoking status (3-month post-op: OR=0.63, p=0.029; 12-month post-op: OR=0.60, p=0.016).

Discussion: Patients who completed greater than 50% of their PROs demonstrated significantly different rates of being employed compared to those who completed less than 50% throughout 1-year of post-surgical follow up. Additional characteristics with positive association for PRO compliance included age, prior spinal surgery, increased BMI, history of radiculopathy or neurogenic claudication. Of the analyzed variables, only preoperative smoking status was associated with decreased compliance throughout follow up. Further investigation, in particular in other cohorts and study sites, is needed to validate our findings and explore additional parameters that affect post-operative compliance of PROs.