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Concordance Between Patients' and Surgeons' Expectations of Cervical Spine Surgery
Carol A Mancuso1,2, Roland Duculan1, Frank P Cammisa1
1Hospital for Special Surgery, New York, NY USA.
Study Design:
Cross-sectional study of patient-surgeon preoperative expectations of cervical surgery.
Objective:
To measure concordance (agreement) between patient-surgeon expectations; to measure associations between expectations and demographic/clinical variables.
Background:
Agreement about expectations should be ensured during preoperative patient-surgeon discussions.
Methods:
Preoperatively patients completed the 20-item Cervical Spine Surgery Expectations Survey measuring expected improvement for symptoms, function and psychological well-being. Response options range from complete to a little improvement; overall score ranges from 0-100 (higher=greater expectations). Surgeons completed an identical surgeons' version of the survey for each patient. Demographic/clinical variables were obtained from patients and medical records. Patient-surgeon agreement was measured for each item with weighted kappa statistics and for overall score with intraclass correlation coefficients (ICC), possible range 0-1.0, (higher=more agreement). Associations with demographic/clinical variables were assessed with multivariable models.
Results:
For 321 patient-surgeon pairs (mean patient age 58, 51% men, 50% radiculopathy, 34% myelopathy) mean patient and surgeon survey scores were 66±21 and 54±18 (patient score greater for 73%). In multivariable analysis, greater patient expectations were associated with younger age, more arm pain, more neck disability, no prior surgery, decreased muscle power, and absent Hoffman sign (P≤.01). Greater surgeon expectations were associated with younger age, more arm pain, more neck disability, no prior surgery, more depressive symptoms, absent Hoffman sign, and present Spurling sign (P≤.04). Regarding patient-surgeon agreement, weighted kappa values were poor (14% items), fair (19%), moderate (57%,) and good (10%). ICC value for the overall score was .50 (moderate agreement) and varied for demographic/clinical variables, e.g. myelopathy/radiculopathy (.51/.44), less/more (.60/.18) neck-related disability. In multivariable analysis, less agreement was associated with extent of surgery and extent of disease on physical examination.
Conclusion:
Using paired methodology and multiple-item surveys there was moderate patient-surgeon agreement for cervical spine surgery expectations. These results support enhanced patient-surgeon discussions of expectations during preoperative consultations.
