The Relation of Patient Expectations, Satisfaction, and... : Spine (original) (raw)

CERVICAL SPINE

The Relation of Patient Expectations, Satisfaction, and Outcome in Surgery of the Cervical Spine

A Prospective Study

Krauss, Philipp MDa,b; Reinartz, Feline MDa; Sonnleitner, Clara MDa; Vazan, Martin MDa,c; Ringel, Florian MDa,d; Meyer, Bernhard MDa; Meyer, Hanno S. MDa

aDepartment of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany

bDepartment of Neurosurgery, University Hospital Augsburg, Augsburg, Germany

cPraxis für Neurochirurgie, Borsbergstrasse 44, Dresden, Germany

dDepartment of Neurosurgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

Address correspondence and reprint requests to Hanno S. Meyer, MD, Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; E-mail: [email protected]

Received 23 November, 2021

Revised 19 January, 2022

Accepted 26 January, 2022

Conceptualization: H.S.M., M.V., F.R., and P.K. Methodology: H.S.M. and P.K.

Formal analysis: P.K., C.S., and H.S.M.

Data curation: C.S. and F.R.

Writing—original draft preparation: P.K. and H.S.M.

Writing—review and editing: H.S.M., M.V., F.R., and P.K. Supervision: H.S.M. and B.M.

All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

The authors declare no conflict of interest.

Study protocol approved by the local ethics committee (TUM: 5749/13).

Study Design.

We performed a prospective nonblinded single center observational study.

Objective.

To investigate the relationship between expectations, outcome, and satisfaction with the outcome in patients undergoing cervical spine stabilization surgery.

Summary of Background Data.

In modern healthcare, patient-reported outcome measures and patient satisfaction have become an important aspect of quality control. Therefore, outcome benchmarks for specific diseases are highly desired. Numerous studies have investigated patient-reported outcome measures and what constitutes satisfaction in degenerative lumbar spine disease. In cervical spine surgery, it is less clear what drives the postoperative symptom burden and patient satisfaction and how this depends on the primary diagnosis and other patient factors.

Methods.

This was a prospective, single center, observational study on patients undergoing cervical spine stabilization surgery for degenerative disease, trauma, infection, or tumor. Using the visual analogue scale for neck and arm pain, the neck disability index (NDI), the modified Japanese Orthopedic Association Score (mJOA) and patient-reported satisfaction, patient status and expectations before surgery, at discharge, 6 and 12 months after surgery were evaluated.

Results.

One hundred five patients were included. Score-based outcome correlated well with satisfaction at 6 and 12 months. Except for low NDI expectations (≥15 points) that correlated with dissatisfaction, expectations in no other score were correlated with satisfaction. Expectations did influence the outcome in some subgroups and meeting expectations resulted in higher rates of satisfaction. Pain reduction plays an important role for satisfaction, independently from the predominant symptom or pathology.

Conclusion.

Satisfaction correlates well with outcome. Meeting expectations did influence satisfaction with the outcome. The NDI seems to be a valuable preoperative screening tool for poor satisfaction at 12 months. In degenerative pathology, pain is the predominant variable influencing satisfaction independently from the predominant symptom (including myelopathy).