A new study released in The Spine Journal examines whether lumbar and cervical spine surgery outcomes meet patients’ expectations.
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Fulfillment of expectations is an important outcome of spine surgery.
To compare fulfillment of expectations after surgery with preoperatively stated expectations.
Prospective cohort studies
Lumbar and cervical spine surgery patients
Self-report valid surveys: [blinded] Lumbar Spine Surgery Expectations Survey, [blinded] Cervical Spine Surgery Expectations Survey, Oswestry Disability Index (ODI), Neck Disability Index (NDI).
Patients preoperatively completed a valid 20-item lumbar or cervical spine surgery Expectations Survey measuring amount of improvement expected for symptoms, physical function, and mental well-being. Two years postoperatively patients were asked about fulfillment of each expectation; a proportion was calculated as of the amount of improvement received versus the amount of improvement expected. The proportion ranges from 0 (no expectations fulfilled) to 1 (all expectations fulfilled as expected) to > 1 (expectations surpassed). Patients also completed the ODI or NDI, and questions about 2-year interval events, such as subsequent surgery.
Among 366 lumbar patients 90% had at least some of their expectations fulfilled (15% expectations surpassed, 9% expectations fulfilled as expected, 66% expectations fulfilled somewhat) and 10% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .66. In multivariable analysis variables that were associated with a lower proportion of expectations fulfilled were: more preoperative expectations, not working full time, previous spine surgery, surgery for more vertebral levels, subsequent spine surgery, and less improvement in pre- to postoperative ODI and pain scores (p≤.05 for all variables). Among 133 cervical surgery patients 91% had at least some of their expectations fulfilled (23% expectations surpassed, 8% expectations fulfilled as expected, 60% expectations fulfilled somewhat) and 9% had none of their expectations fulfilled; the mean proportion of expectations fulfilled was .78. In multivariable analysis variables that were associated with a lower proportion of expectations fulfilled were: more preoperative expectations and less improvement in pre- to postoperative NDI and pain scores (p≤.05 for all variables).
Fulfillment of expectations after spine surgery is associated with multiple pre- and postoperative variables, including amount of improvement expected preoperatively.