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Fulfillment of Surgeons' and Patients' Preoperative Expectations of Cervical Spine Surgery and Patient-Reported
Carol A Mancuso1,2, Roland Duculan1, Frank P Cammisa1
1Hospital for Special Surgery, New York, NY USA.
Study Design:
Two-year longitudinal study of various outcomes of cervical spine surgery.
Objective:
To compare proportions of surgeons' and patients' fulfilled expectations to other outcome measures.
Background:
Fulfillment of surgeons' and patients' expectations are relevant outcomes of cervical surgery.
Methods:
Preoperatively surgeons and patients completed paired validated 20-item surveys for expected improvement in symptoms, function and psychological well-being. Patients also completed the Neck Disability Index (NDI) and numeric ratings of neck and arm pain. Two years postoperatively patients completed these same surveys plus measures of general and affective satisfaction. Proportions of expectations fulfilled (i.e. improvement received divided by improvement expected) for surgeons and patients (range 0-1,.62 MCID) and improvement in NDI (MCID>14) and neck/arm pain (MCID ≥3) were calculated; a composite of sub-optimal global satisfaction also was defined. Hierarchical models accounting for surgeon were used to compare outcomes and demographic/clinical covariates.
Results:
Patient mean age was 58, 52% were men; 5 spine surgeons participated. Proportion of patients' expectations fulfilled was.99 (range 0-2.80, 90% met MCID); in multivariable analysis better preoperative NDI score (est 1.62; CI 1.35-1.89; P <.0001) and greater improvement in pre- to postoperative NDI score (est 1.54; CI 1.27-1.81; P <.0001) were associated. Proportion of surgeons' expectations fulfilled was 1.23; in multivariable analysis older age (est.63; CI.10-1.16; P =.02), fewer depressive symptoms (1.12; CI.08-2.15; P =.04), less neck pain (3.52; CI 1.40-5.65; P =.001), intact sensation (14.68; CI.89-28.47; P =.04), and no Spurling sign (13.89; CI.08-27.70; P =.05) were associated. MCID thresholds were met for NDI (75%), neck pain (75%), and arm pain (63%). Sub-optimal global satisfaction (38%) was associated with lower patient proportion of expectations fulfilled ( P <.0001) and not meeting NDI/neck/arm pain MCID thresholds ( P <.05).
Conclusion:
Proportions of surgeons' and patients' expectations fulfilled are distinct patient-centered outcomes associated with relevant clinical variables of cervical spine surgery.
