Queen Elizabeth II Health Sciences Center, Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Spine (Phila Pa 1976). 2012 Jan 15;37(2):E103-8. doi: 10.1097/BRS.0b013e3182245c1f.
Analysis of prospectively collected multicenter data.
To explore the relationship between preoperative expectations and postoperative outcomes and satisfaction in lumbar and cervical spine surgery.
Back pain is one of the most common health problems, leading to the utilization of health care resources, work loss, and sick benefits. Patient expectations influence posttreatment outcomes, both surgical and nonsurgical. There is little research on the importance of preoperative expectations in spine surgery. Existing studies evaluate the technical aspects of interventions and functional outcomes but fail to take into account patient expectations. The authors hypothesized that expectations dramatically affect spine patient satisfaction independent of functional outcomes.
Prospectively collected patient-entered data from patients undergoing lumbar and cervical spine surgery from 2 study centers collected using a Web-based patient health survey system were analyzed. The study included patients who underwent operative intervention (decompression with or without fusion) with at least a 3-month period of follow-up. Preoperative expectations were measured using the Musculoskeletal Outcomes Data Evaluation and Management System's (MODEMS) expectation survey. Postoperative satisfaction and fulfillment of expectations were measured using the MODEMS satisfaction survey. Postoperative functional outcomes were measured using the Oswestry Disability Index and 36-item short form health survey. Ordinal logistic regression multivariate modeling was used to examine predictors of postoperative satisfaction. Linear regression multivariate modeling was used to examine predictors of functional outcomes.
Greater fulfillment of expectations led to higher postoperative satisfaction and was associated with better functional outcomes. Higher preoperative expectations led to decreased postsurgical satisfaction but were associated with improved functional outcomes. Higher postoperative satisfaction was associated with improved functional outcomes and vice versa. Type of surgery also influenced satisfaction and function, with cervical patients being less satisfied but having better functional outcomes than lumbar patients.
This study showed that more than functional outcomes matter; preoperative expectations and fulfillment of expectations influence postoperative satisfaction in patients undergoing lumbar and cervical spine surgery. This underlines the importance of taking preoperative expectations into account to obtain an informed choice on the basis of the patient's preferences.
前瞻性收集的多中心数据分析。
探讨腰椎和颈椎手术患者术前期望与术后结果和满意度之间的关系。
腰痛是最常见的健康问题之一，导致医疗资源的利用、工作损失和病假津贴。患者的期望影响治疗后的结果，包括手术和非手术治疗。关于脊柱手术中术前期望的重要性研究甚少。现有研究评估干预措施的技术方面和功能结果，但未能考虑到患者的期望。作者假设，期望对脊柱患者的满意度有显著影响，独立于功能结果。
使用基于网络的患者健康调查系统，对来自 2 个研究中心接受腰椎和颈椎手术的患者前瞻性收集的患者输入数据进行分析。研究包括接受手术干预（减压伴或不伴融合）且随访至少 3 个月的患者。使用肌肉骨骼结果数据评估和管理系统的（MODEMS）期望调查来测量术前期望。使用 MODEMS 满意度调查来测量术后满意度和期望的满足程度。使用 Oswestry 残疾指数和 36 项简短健康调查来测量术后功能结果。使用有序逻辑回归多变量建模来检查术后满意度的预测因素。使用线性回归多变量建模来检查功能结果的预测因素。
更高的期望满足度导致更高的术后满意度，并与更好的功能结果相关。更高的术前期望导致术后满意度降低，但与改善的功能结果相关。更高的术后满意度与改善的功能结果相关，反之亦然。手术类型也影响满意度和功能，颈椎患者的满意度较低，但功能结果优于腰椎患者。
本研究表明，不仅仅是功能结果重要；腰椎和颈椎手术患者的术前期望和期望的满足度影响术后满意度。这强调了考虑术前期望以根据患者的偏好做出明智选择的重要性。
