High-Frequency Global Postoperative Status PROMs Track Pain Peaks and Analgesic Use After Degenerative Lumbar Spine Surgery
Global Spine J. 2026 Jun 5:21925682261449153. doi: 10.1177/21925682261449153. Online ahead of print.
ABSTRACT
Study Design Prospective observational cohort study.
Objective Standard postoperative follow-up often fails to capture rapid fluctuations in symptoms after degenerative lumbar spine surgery. This study evaluated the construct validity of a high-frequency, low-burden "Global Postoperative Status" item as an exploratory measure of concurrent early post-discharge recovery burden.
Methods Prospective observational cohort study of 257 patients undergoing surgery for lumbar disc herniation or spinal canal stenosis who contributed 1627 postoperative status assessments over 6 weeks via secure mobile surveys every 2-3 days. Construct validity was examined through associations with pain-peak frequency, pain-peak intensity (0-10), analgesic use, and wound pain. Because peak intensity was conditionally collected only when pain peaks were reported, the primary mixed-effects complete-case model included 209/1627 assessments (82 subjects); broader sensitivity analyses used larger available-case datasets.
Results Worse Global Status scores were consistently associated with greater concurrent pain burden. Median status was 60 (IQR 50-80) when no pain peaks were reported vs 40 (IQR 20-50) when pain peaks occurred >5/day. Mean status was 67.2 without analgesics and 41.9 with combined opioid plus non-opioid analgesics. Status correlated inversely with pain peak intensity (Spearman rho = -0.53, P < 0.001). In the exploratory complete-case mixed-effects model, each 1-point increase in pain peak intensity was associated with a 4.53-point lower status score (95% CI -6.09 to -2.97; P < 0.001); this direction was preserved in broader sensitivity analyses that retained more observations.
Conclusions The high-frequency Global Status item showed exploratory construct-validity evidence as a low-burden indicator of concurrent postoperative pain burden and analgesic use after lumbar spine surgery. The findings do not establish responsiveness, test-retest reliability, criterion validity against established PROMs, or decision-support utility, and prospective validation studies are required before clinical implementation claims can be made.
PMID:42246892 | DOI:10.1177/21925682261449153