Do patient expectations of spinal surgery relate to functional outcome?

Abstract

It is important for surgeons to understand patients' expectations for surgery. We asked whether patient factors and preoperative functional outcome scores reflect the degree of expectations patients have for posterior spinal surgery. Second, we asked whether patients' expectations for surgery predict improvements in functional outcome scores after surgery. We prospectively enrolled 155 consecutive surgical patients with greater than 90% followup. Patients' expectations were evaluated preoperatively along with SF-36 and Oswestry disability questionnaires. Postoperatively (6 months for decompression; 1 year for fusions), we quantified patient-derived satisfaction regarding whether expectations were met and by patient-derived functional outcome scores. In patients undergoing decompression, gender, SF-36 general health domain, and SF-36 physical component score predicted patients with high expectations for surgery. Patients with high expectations also reported greater postoperative improvements in SF-36 role physical domain scores after surgery. Expectations for surgery were met in 81% of patients. In a subset of patients (21 of 143), expectations were not met. These patients reported lower mean preoperative SF-36 general health, vitality, and mean mental component scores.

Figures

Fig. 1

This consort flow chart depicts patient recruitment and followup during the study period.

Fig. 2

Patients generally had higher expectations for relief of leg versus back pain and for improvements in sleep and return to household and recreational activities. There appeared to be a lower expectation for return to work-related activities.

Fig. 3

The majority of patients believed their expectations for surgery were met in the seven categories relating to symptoms and physical function.