McGregor Alison H, Doré Caroline J, Morris Tim P
Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital Campus, London, W6 8RP, UK,
Eur Spine J. 2013 Dec;22(12):2836-44. doi: 10.1007/s00586-013-2971-6. Epub 2013 Aug 30.
The majority of studies of surgical outcome focus on measures of function and pain. Increasingly, however, the desire to include domains such as patients' satisfaction and expectations had led to the development of simple measures and their inclusion into clinical studies. The purpose of this study was to determine patients' pre-operative expectations of and post-operative satisfaction with the outcome of their spinal surgery.
As part of the FASTER randomised controlled trial, patients were asked pre-operatively to quantify their expected improvement in pain and health status at 6 weeks, 6 and 12 months following surgery using 100 mm visual analogue scales (VAS), and to indicate their confidence in achieving this result and also the importance of this recovery to them. Patients were then asked to rate their satisfaction with the improvement achieved at each post-operative review using 100 mm VAS.
Although differences between patients' expectation and achievement were minimal 6 weeks post-operatively, there was a clear discrepancy at 6 months and 1 year, with patient expectations far exceeding achievement. There were significant correlations between failure to achieve expectations and the importance patients attached to this recovery at each post-operative assessment, but not with their confidence in achieving this result. Satisfaction levels remained high despite expectations not being met, with discectomy patients being more satisfied than decompression patients.
Patients' pre-operative expectations of surgical outcome exceed their long-term achievement. The more importance the patient attached to a good outcome, the larger is the discrepancy between expectation and achievement. Despite this, satisfaction levels remained high. The impact of unrealistic expectations on outcome remains unclear.
大多数关于手术结果的研究都集中在功能和疼痛的测量上。然而，越来越多的人希望将患者满意度和期望等领域纳入研究，这促使了简单测量方法的开发并将其纳入临床研究。本研究的目的是确定患者对脊柱手术结果的术前期望和术后满意度。
作为FASTER随机对照试验的一部分，患者在术前被要求使用100毫米视觉模拟量表（VAS）量化他们对术后6周、6个月和12个月时疼痛和健康状况改善的预期，并表明他们对实现这一结果的信心以及这种恢复对他们的重要性。然后要求患者使用100毫米VAS对每次术后复查时所取得的改善进行满意度评分。
尽管术后6周患者的期望与实际结果之间的差异很小，但在6个月和1年时存在明显差异，患者期望远远超过实际结果。在每次术后评估中，未达到期望与患者对这种恢复的重视程度之间存在显著相关性，但与他们对实现这一结果的信心无关。尽管未达到期望，但满意度水平仍然很高，椎间盘切除术患者比减压手术患者更满意。
患者对手术结果的术前期望超过了他们的长期实际结果。患者对良好结果越重视，期望与实际结果之间的差异就越大。尽管如此，满意度水平仍然很高。不切实际的期望对结果的影响仍不清楚。
