Performance of the Streamlined Quality Outcomes Database Web-based Calculator: Internal and External Validation

Leah Y Carreon*, Hui Nian, Kristin R Archer, Mikkel Ø Andersen, Karen Højmark Hansen, Steven D Glassman


Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


BACKGROUND CONTEXT: With an increasing number of web-based calculators designed to provide the probabilities of an individual achieving improvement after lumbar spine surgery, there is a need to determine the accuracy of these models.

PURPOSE: To perform an internal and external validation study of the reduced Quality Outcomes Database Web-based Calculator (QOD-Calc).

STUDY DESIGN: Observational Longitudinal cohort PATIENT SAMPLE: Patients enrolled study-wide in QOD and patients enrolled in DaneSpine at a single institution who had elective lumbar spine surgery with baseline data to complete QOD-Calc and 12-month post-operative data.

OUTCOME MEASURES: Oswestry Disability Index (ODI), Numeric Rating Scales (NRS) for Back and Leg Pain, EuroQOL-5D (EQ-5D) METHODS: Baseline data elements were entered into QOD-Calc to determine the probability for each patient having Any Improvement and 30% Improvement in NRS Leg Pain, Back Pain, EQ-5D and ODI. These probabilities were compared to the actual 12-month post-op data for each of the QOD and DaneSpine cases. Receiver-Operating Characteristics Analyses were performed and Calibration plots created to assess model performance.

RESULTS: 24,755 QOD cases and 8,105 DaneSpine lumbar cases were included in the analysis. QOD-Calc had acceptable to outstanding ability (AUC: 0.694 to 0.874) to predict Any Improvement in the QOD cohort and moderate to acceptable ability (AUC: 0.658 to 0.747) to predict 30% Improvement. QOD-Calc had acceptable to exceptional ability (AUC: 0.669 to 0.734) to predict Any improvement and moderate to exceptional ability (AUC:0.619 to 0.862) to predict 30% Improvement in the DaneSpine cohort. AUCs for the DaneSpine cohort was consistently lower that the AUCs for the QOD Validation cohort.

CONCLUSION: QOD-Calc performs well in predicting outcomes in a patient population that is similar to the patients that was used to develop it. Although still acceptable, model performance was slightly worse in a distinct population, despite the fact that the sample was more homogenous. Model performance may also be attributed to the low discrimation threshold, with close to 90% of cases reporting Any Improvement in outcome. Prediction models may need to be developed that are highly specific to the characteristics of the population.

TidsskriftThe Spine Journal
Udgave nummer4
Sider (fra-til)662-669
StatusUdgivet - apr. 2024

Bibliografisk note

Copyright © 2023. Published by Elsevier Inc.


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