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Category: Other Introduction/Purpose: Patient factors such as resilience and mental health play a vital role in perception of pain and surgical outcomes. Increasingly, practices are incorporating psychosocial and mental health patient-reported outcome (PRO) surveys into patient assessment. Individual PROs, such as measures of patient resilience, have been found to correlate with post-surgical outcomes in the orthopaedic population. To date, however, there has been little investigation comparing the efficacy of psychosocial PROs in the foot and ankle population. This study's objective was to evaluate the role of resilience, depression, and global mental health in foot and ankle surgical outcomes and establish the benefits and limitations of each PRO. Methods: Consecutive patients undergoing foot and ankle orthopaedic surgery at a single institution were enrolled in the U- COSMOS platform, an automated outcomes data repository. Patients were included for analysis if they had baseline and minimum 6-month follow-up outcome scores. If more than one follow-up was available, the longest available outcome was used. As measures of physical health, PROMIS Physical Function CAT (PF), PROMIS Pain Interference CAT (PI), Foot and Ankle Single Assessment Numeric Evaluation (FA SANE), and PROMIS Global Physical Health (GPH) were collected. Psychosocial factors were assessed using the Brief Resilience Scale (BRS), PROMIS Depression CAT, and PROMIS Global Mental Health (GMH). Patients lower than, within, and higher than one standard deviation of the average for each psychosocial outcome were divided into three groups. Differences were assessed using ANOVA and corrected for demographics. Results: 725 patients who underwent foot and ankle surgery were included. At longest follow-up, we found that patients reporting higher pre-operative BRS, higher pre-operative GMH, and lower pre-operative Depression report significantly higher follow-up physical health outcomes in all domains (p < 0.05, see Table 1). Importantly, we found stark differences between psychosocial factors when assessing baseline outcomes and post-surgical improvement at longest follow-up. At baseline, GMH and Depression are associated with higher pre-surgical scores in nearly all physical health domains, while BRS is not. Inversely, BRS is associated with higher post-surgical improvement, while GMH and Depression are not. Supporting these findings, baseline Depression and GMH are more strongly correlated with one another (r = 0.67) than with BRS (r = 0.53 and r = 0.46, respectively). Conclusion: We found that patients with higher pre-operative psychosocial PROs reported greater physical health outcomes at follow-up. Patients with high resilience also reported greater improvement in PROs compared to baseline. While global mental health and depression may be associated with physical health scores at a single moment in time, our findings suggest patient resilience plays a larger role in predicting improvement following surgery. Further investigation is warranted to determine the effect resilience scores have on outcomes for specific procedures and conditions. Additionally, interventions to improve patient resilience may be most beneficial for a patient’s long term improvement following surgery.

Category: Other; Ankle; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The automation and integration of patient reported outcomes (PROs) into standard of care practice and electronic health systems is becoming increasingly viable. While often collected as a quality assurance measure for a practice and surgical decision-making, PROs are also valuable to assess the relative treatment outcomes. In order for physicians to gain the most insight from PROs, more baseline outcomes are needed to serve as a benchmark of anticipated patient improvement following surgical interventions. The goal of this study is to evaluate differences in patient improvement among validated physical and mental health PROs in a foot and ankle surgery practice. Methods: Consecutive patients undergoing foot and ankle surgery were enrolled into the U-COSMOS pathway. All PROs are automatically distributed and tracked through a secure, HIPAA-compliant, online PRO data capture tool. All patients are invited to complete the PROMIS Physical Function (PF) Computer Adaptive Test (CAT), PROMIS Pain Interference CAT (PI), Foot and Ankle Single Assessment Numeric Evaluation (SANE), PROMIS Global Physical Health (GPH), PROMIS Global Mental Health (GMH), PROMIS Depression, and a brief resiliency scale (BRS). PROs are collected pre-operatively, and post-operatively at 3- months, 6-months, 12-months, and 24-months. In this study, differences between pre- and post-operative scores for each PRO are evaluated using an unpaired Mann-Whitney U Test. Results: To date, 3154 patients have been enrolled into the U-COSMOS foot and ankle surgery pathway. Overall survey compliance was 77%. A significant improvement was seen in PF, PI, SANE, and GPH at 6-months, 12-months, and 24-months (p < 0.0001, see Table 1). There was no significant improvement in PF or GPH at the 3-month mark, supporting reduction of pain interference may be observed before return of physical function. All PROs measuring changes in mental health or resilience (Depression, GMH, BRS) did not significantly change at any post-operative visit relative to baseline. We found a mild positive correlation between BRS and improved 12-month PF and PI outcomes and a mild inverse correlation between pre-operative depression and 12-month PI and PF scores. Conclusion: Our data suggests that foot and ankle surgery leads to significant improvement in physical outcomes such as function or pain interference, but mental health and resilience outcomes remain somewhat unchanged throughout treatment on average. Within physical outcomes, we also find significant improvement in pain interference precedes functional and general measures. Early findings from the U-COSMOS outcomes pathway demonstrates greater overall improvement in physical health PROs, and a sustained improvement up to 24 months post-op. Future investigation of outcomes specific to procedures and conditions within the U-COSMOS pathway will help elucidate anticipated variation from general trends.