Patients' expectations of cervical spine surgery.

STUDY DESIGN

Cross-sectional analysis of patients' expectations of cervical spine surgery using the Hospital for Special Surgery Cervical Spine Surgery Expectations Survey (Expectations Survey).

OBJECTIVE

To preoperatively describe patients' long-term expectations of surgery in terms of demographic, clinical, and psychological characteristics.

SUMMARY OF BACKGROUND DATA

Although important components of patient-centered care, few studies have systematically considered patients' expectations of cervical spine surgery.

METHODS

Several days before surgery, 150 patients completed the Expectations Survey, which is composed of 20 physical and psychological items; scores range from 0 to 100, and higher scores reflect choosing more items and more improvement (i.e., more expectations). Patients completed additional questionnaires addressing demographic, psychological, and clinical status, including disability due to pain with the Neck Disability Index (NDI) and overall physical and mental health with the 12-item Short Form Health Survey.

RESULTS

Mean age was 54 years, and 61% were males. The most commonly chosen items were relieve neck (87%) and upper extremity (85%) pain, stop the spine condition from getting worse (97%), and remove the control the spine condition had on life (96%). Twenty-three percent of patients chose all 20 items, 39% chose 16 to 19 items, and 38% chose 15 or fewer items. In multivariate analysis, patients were more likely to choose more items if they were younger (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2-4.0; P = 0.01), had worse NDI scores (OR = 6.5; 95% CI, 3.2-13.2; P < 0.0001), and had worse SF-12 Physical (OR = 1.9; 95% CI, 1.0-3.6; P = 0.05) and Mental Health scores (OR = 2.0; 95% CI, 1.1-3.6; P = 0.02). The Expectations Survey scores ranged from 10 to 100, and the mean score was 65 ± 24. In multivariate analysis, patients were more likely to have higher scores if they were younger (OR = 2.8; 95% CI, 1.4-6.0; P = 0.006) and had worse NDI scores (OR = 6.0; 95% CI, 2.8-13.2; P < 0.0001).

CONCLUSION

Multiple clinical variables were associated with expectations, with younger age and more disability due to pain being the most consistently associated with more expectations.

LEVEL OF EVIDENCE