Postoperative satisfaction following lumbar spinal fusion surgery: patient expectation versus actuality

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OBJECTIVE

Due to the reported benefits associated with minimally invasive spine surgery (MIS), patients seeking out minimally invasive surgery may have higher expectations regarding their outcomes. In this study the authors aimed to assess the effects of preoperative expectations and postoperative outcome actuality, and the difference between the two, on postoperative satisfaction following MIS for lumbar fusion procedures.

METHODS

Patients scheduled for either a 1- or 2-level lumbar fusion MIS were administered confidential surveys preoperatively and at 6 months postoperatively. The surveys administered preoperatively consisted of 2 parts: preoperative patient-reported outcomes (PROs), including the Oswestry Disability Index (ODI), visual analog scale (VAS) back pain, and VAS leg pain, and expected postoperative PROs. The surveys administered 6 months postoperatively consisted of 2 parts: postoperative PROs and satisfaction. Preoperative symptoms, expected postoperative symptoms, and actual postoperative symptoms were compared using paired t-tests. Pearson correlation was used to compare the association between 1) postoperative change in PROs and satisfaction, 2) expectation and satisfaction, 3) expectation-actuality discrepancy and satisfaction, and 4) actuality and satisfaction.

RESULTS

In total, 101 patients completed all surveys. Patients expected to improve in all PROs from baseline, except for ODI personal care, in which they expected to get worse after surgery. In actuality, patients improved in all PROs from baseline, except for ODI personal care, in which they did not demonstrate improvement or worsening. Patients did not surpass any expectations regarding PRO improvement. The association between patient satisfaction and postoperative change was strong for the VAS back pain score, while ODI and VAS leg pain scores showed moderate correlations. Preoperative expectation and postoperative satisfaction demonstrated weak to moderate correlations for all outcome measures. All 3 PROs demonstrated moderate correlation between patient satisfaction and the expectation-actuality discrepancy. All 3 PROs demonstrated strong correlations between satisfaction and actual postoperative outcomes, with ODI having the strongest correlation.

CONCLUSIONS

In this observational study, the authors determined that the actual postoperative results following surgery were strongly correlated with patient satisfaction, while the patients’ expectation, the expectation-actuality discrepancy, and the postoperative improvement did not demonstrate strong correlations for all patient-reported outcome measures utilized in this study. The investigation results suggest that the most important indicator of how satisfied patients feel following surgery may be the actual outcome itself, rather than the preoperative expectation or the degree to which the expected result was met.

ABBREVIATIONS MIS = minimally invasive spine surgery; ODI = Oswestry Disability Index; PRO = patient-reported outcome; VAS = visual analog scale.

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Article Information

Correspondence Kern Singh: Rush University Medical Center, Chicago, IL. kern.singh@rushortho.com.

INCLUDE WHEN CITING Published online July 26, 2019; DOI: 10.3171/2019.5.SPINE19213.

Disclosures Dr. Singh reports being a consultant for Zimmer Biomet and K2M; board membership in Vital 5 LLC, TDi LLC, and the Minimally Invasive Spine Study Group; membership on the editorial board for Contemporary Spine Surgery, Orthopedics Today, and Vertebral Columns; receiving royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, and Slack Publishing; and receiving grants from the Cervical Spine Research Society.

© AANS, except where prohibited by US copyright law.

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    Patient satisfaction compared to actual postoperative outcomes based on ODI score. Figure is available in color online only.

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    Patient satisfaction compared to actual postoperative outcomes based on VAS back pain score. Figure is available in color online only.

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    Patient satisfaction compared to actual postoperative outcomes based on VAS leg pain score. Figure is available in color online only.

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