Grob Dieter, Mannion Anne F
Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland.
Eur Spine J. 2009 Aug;18 Suppl 3(Suppl 3):380-5. doi: 10.1007/s00586-009-1005-x. Epub 2009 Apr 24.
Recent years have witnessed a paradigm shift in relation to the assessment of outcome in spine surgery: multidimensional patient-centred questionnaires have superseded traditional surgeon-based ratings of outcome, and surgical registries have been developed to capitalise on the principle of "strength in numbers." However, the assessment of complications has not enjoyed this same enlightened patient-centred approach. The present study investigated post-surgical complications from the patient's perspective. All German-speaking patients undergoing surgery within our Spine Center in 2005 were asked to complete the patient-orientated Core Measures Outcome Index of the SSE Spine Tango Spine Surgery Registry before and 12 months after surgery; the surgeon completed a Spine Tango surgery form. In the 12-month questionnaire, the patient was asked, "did any complications arise as a consequence of your operation 1 year ago (e.g. problems with wound healing, paralysis, sensory disturbances, etc.)? If so, give details." Patients were also asked about their satisfaction with the operation and the global outcome of surgery. 1,035 patients were sent a 12-month questionnaire; 972 (94%) returned the completed questionnaire. 29% patients answered "yes" to the question about complications. The incidence of patient-rated complications was significantly associated with outcome/satisfaction (P < 0.05), suggesting these complications were not trivial to the patient. The results indicate that, just like outcome, "complications" should be assessed from both the patient's and the surgeon's perspectives, not least to better understand the reasons accounting for dissatisfaction and a poor patient-rated outcome.
近年来，脊柱外科手术结果评估发生了范式转变：以患者为中心的多维问卷已取代了传统的基于外科医生的结果评级，并且已建立手术登记处以利用“数量优势”原则。然而，并发症评估并未采用这种同样开明的以患者为中心的方法。本研究从患者角度调查了术后并发症。2005年在我们脊柱中心接受手术的所有德语患者被要求在手术前和术后12个月完成SSE脊柱探戈脊柱手术登记处的以患者为导向的核心指标结果指数；外科医生填写了一份脊柱探戈手术表格。在12个月的问卷中，患者被问及：“你一年前的手术是否引发了任何并发症（例如伤口愈合问题、瘫痪、感觉障碍等）？如果是，请详细说明。”患者还被问及他们对手术的满意度以及手术的总体结果。向1035名患者发送了12个月的问卷；972名（94%）患者返回了填好的问卷。29%的患者对关于并发症的问题回答“是”。患者报告的并发症发生率与结果/满意度显著相关（P<0.05），这表明这些并发症对患者来说并非微不足道。结果表明，与手术结果一样，“并发症”也应从患者和外科医生两个角度进行评估，尤其是为了更好地理解导致患者不满和患者报告结果不佳的原因。
