Relationship Between Pre-Operative Expectations, Satisfaction and Functional Outcomes in Lumbar and Cervical Spine Patients: a Multi Center Study.

Relationship Between Pre-Operative Expectations, Satisfaction and Functional Outcomes in Lumbar and Cervical Spine Patients: a Multi Center Study.

Spine (Phila Pa 1976). 2011 Jun 2;

Authors: Soroceanu A, Ching A, Abdu W, McGuire K

ABSTRACT: Study Design: Analysis of prospectively collected multi-center data.Objective: To explore the relationship between pre-operative expectations and post-operative outcomes and satisfaction in lumbar and cervical spine surgery.Summary of background Data: Back pain is one of the most common health problems, leading to the utilization of healthcare resources, work loss, and sick benefits. Patient expectations influence post-treatment outcomes, both surgical and non-surgical. There is little research on the importance of pre-operative expectations in spine surgery. Existing studies evaluate the technical aspects of interventions and functional outcomes but fail to take into account patient expectations. The authors hypothesized that expectations dramatically affect spine patient satisfaction independent of functional outcomes.Methods: Prospectively collected patient entered data from lumbar and cervical spine patients from two study centers collected using a web based patient health survey system was analyzed. The study included patients who underwent operative intervention (decompression with or without fusion) with at least a 3-month period of follow-up. Pre-operative expectations were measured using the MODEMS expectation survey. Post-operative satisfaction and fulfillment of expectations were measured using the MODEMS satisfaction survey. Post-operative functional outcomes were measured using the ODI and SF-36. Ordinal logistic regression multi-variate modeling was used to examine predictors of post-operative satisfaction. Linear regression multi-variate modeling was used to examine predictors of functional outcomes.Results: Greater fulfillment of expectations led to higher post-operative satisfaction and were associated with better functional outcomes. Higher pre-operative expectations led to decreased post-surgical satisfaction, but were associated with improved functional outcomes. Higher post-operative satisfaction was associated with improved functional outcomes and vice-versa. Type of surgery also influenced satisfaction and function, with cervical patients being less satisfied but having better functional outcomes than lumbar patients.Conclusion: This study showed that more than functional outcomes matter; pre-operative expectations and fulfillment of expectations influence post-operative satisfaction in lumbar and cervical spine patients. This underlines the importance of taking pre-operative expectations into account in order to obtain an informed choice based on the patient’s preferences.

PMID: 21629159 [PubMed – as supplied by publisher]