Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery

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OBJECTIVE

Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery.

METHODS

A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years − score at baseline) data.

RESULTS

A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49–0.55), and function (r = 0.41–0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction.

CONCLUSIONS

Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.

ABBREVIATIONS ASA-PS = American Society of Anesthesiologists Physical Status; ASD = adult spinal deformity; CA = clavicle angle; GT = global tilt; HRQOL = health-related quality of life; LIV = lower instrumented vertebra; LL = lumbar lordosis; LLI = LL index; MCS = Mental Component Summary; NRS = numeric rating scale; ODI = Oswestry Disability Index; PCS = Physical Component Summary; PI = pelvic incidence; PI-LL = PI − LL; PT = pelvic tilt; Sat-2y = satisfaction at 2 years; SI = self-image; SRS-22R = Scoliosis Research Society-22; SVA = sagittal vertical axis; TK = thoracic kyphosis.
Article Information

Contributor Notes

Correspondence Kazunori Hayashi: Osaka City University Graduate School of Medicine, Osaka, Japan. m0028898@msic.med.osaka-cu.ac.jp.INCLUDE WHEN CITING Published online May 10, 2019; DOI: 10.3171/2019.2.SPINE181486.Disclosures The ESSG is supported by grants from DePuy Synthes and Medtronic. Dr. Hayashi: grant from Konishi Foundation for International Exchange. Dr. Boissière: consultant for Spineart and Medicrea, and support from DePuy for the current study. Dr. Pellisé and Dr. Acaroğlu: support from DePuy and Medtronic for the study described; and consultant for AOSpine. Dr. Sánchez Pérez-Grueso: support from DePuy for the study described, and consultant for K2M. Dr. Kleinstück: support from DePuy for the study described. Dr. Alanay: support from DePuy Synthes and Medtronic for the study described. Dr. Obeid: consultant for DePuy Synthes and Medtronic; support from DePuy Synthes for the study described; and royalties from Alphatec, Clariance, and Spineart.

© AANS, except where prohibited by US copyright law.

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