Lattig Friederike, Fekete Tamás Fülöp, OʼRiordan David, Kleinstück Frank S, Jeszenszky Dezsö, Porchet François, Mutter Urs, Mannion Anne F
*Schulthess Klinik, Zürich, Switzerland; and †Department of Orthopedic Surgery, University of Ulm, Ulm, Germany.
Spine (Phila Pa 1976). 2013 May 20;38(12):1040-8. doi: 10.1097/BRS.0b013e318269c100.
Cross-sectional study of agreement between patients' and surgeons' expectations of the outcome of spinal surgery.
Patients' satisfaction after spinal surgery depends, in part, on whether their expectations of surgery are fulfilled. Whether the patient always fully understands the key messages conveyed by the surgeon, to formulate realistic expectations, is not known. This study evaluates the level of agreement in expectations declared preoperatively by the patient and the surgeon.
Previous studies have investigated the importance of realistic expectations for the patients' satisfaction with surgical treatments, but there is still a need for a more detailed analysis in the field of spinal surgery.
The study included 225 German-speaking patients (92 men and 133 women; mean ± SD [range] age, 62 ± 15 [15-90] yr) and their treating spinal surgeons (N = 7). Following the preoperative informed consent consultation, the patient and the surgeon independently completed a questionnaire about baseline neurological status and realistic expectations regarding various patient-orientated outcomes (axial pain (back/neck), radiating pain (leg/arm), pain medication usage, sensory and motor function, and the ability to work, do household activities, and play sports). Concordance was given by percent agreement and κ coefficients.
Agreement between the patient and the surgeon about the existence of spine-related neurological deficits occurred in 75% (sensory) and 61% (motor) cases. The patient but not the surgeon reported a sensory deficit in 20% cases and motor deficit in 35% cases; for 4% to 5% cases, the physician reported such a deficit that the patient was seemingly unaware of. The patients consistently had higher expectations than the surgeons, especially for back or neck pain and function (work, household activities, and sports); weighted κ values for agreement were low, ranging from 0.097 to 0.222.
The findings demonstrate wide discrepancies between the patient and the surgeon regarding the expected result of surgery. They highlight the need for clearer explanations of the association between the spinal problem and neurological deficits and the improvement that can be expected in pain and function after surgery. Systematic, routine evaluation of outcomes should assist in deriving the information necessary to document the improvement achieved and to formulate realistic expectations of surgery.
关于患者与外科医生对脊柱手术结果期望一致性的横断面研究。
脊柱手术后患者的满意度部分取决于其手术期望是否实现。患者是否总能完全理解外科医生传达的关键信息以形成现实的期望尚不清楚。本研究评估患者和外科医生术前声明的期望一致程度。
先前的研究调查了现实期望对患者手术治疗满意度的重要性，但在脊柱外科领域仍需要更详细的分析。
该研究纳入了225名说德语的患者（92名男性和133名女性；平均±标准差[范围]年龄，62±15[15 - 90]岁）及其治疗脊柱外科医生（N = 7）。在术前知情同意咨询后，患者和外科医生独立完成一份关于基线神经学状态以及对各种以患者为导向的结果（轴向疼痛（背部/颈部）、放射痛（腿部/手臂）、疼痛药物使用、感觉和运动功能以及工作、做家务和运动的能力）的现实期望的问卷。一致性通过百分比一致性和κ系数表示。
患者与外科医生关于存在与脊柱相关的神经功能缺损的一致性在感觉方面为75%，在运动方面为61%。20%的病例中患者报告有感觉缺损而外科医生未报告，35%的病例中患者报告有运动缺损而外科医生未报告；在4%至5%的病例中，医生报告了患者似乎未意识到的此类缺损。患者的期望始终高于外科医生，尤其是在背部或颈部疼痛及功能（工作、家务活动和运动）方面；一致性的加权κ值较低，范围为0.097至0.222。
研究结果表明患者与外科医生在手术预期结果方面存在广泛差异。它们强调需要更清晰地解释脊柱问题与神经功能缺损之间的关联以及手术后疼痛和功能方面可预期的改善。对结果进行系统、常规的评估应有助于获取记录所取得的改善和形成现实手术期望所需的信息。
