Chotai Silky, Sivaganesan Ahilan, Parker Scott L, McGirt Matthew J, Devin Clinton J
*Department of Orthopedics Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
Neurosurgery. 2015 Aug;77(2):157-63; discussion 163. doi: 10.1227/NEU.0000000000000768.
Patient satisfaction metrics are emerging as determinants of quality of care and reimbursement after spine surgery. Identifying modifiable factors that improve satisfaction is of utmost importance.
To evaluate whether patient-related factors or patient-reported outcomes could predict dissatisfaction after spine surgery.
Patients undergoing elective surgery for degenerative lumbar and cervical disease over a period of 2 years were enrolled in a prospective longitudinal registry. Patient-reported outcome, the Oswestry Disability Index (ODI)/Neck Disability Index (NDI), and numeric rating scale for back/neck (BP/NP) and leg/arm pain (LP/AP), were recorded at baseline and the 12-month follow-up. Previously published values of minimal clinically important differences of 14.9% for ODI, 17.3% for NDI, 2.1/2.6 for BP/NP, and 2.8/4.1 for LP/AP were used. Patient satisfaction was assessed with the North American Spine Society Satisfaction Questionnaire.
A total of 1645 patients underwent elective spine surgery (811 male patients; age, 57 ± 13 years). Eighty-three percent of patients (1362) reported satisfaction with outcome 12 months after surgery. In a multivariable analysis, after controlling for an array of patient-specific factors, the inability to achieve minimal clinically important difference for ODI/NDI (P < .001; odds ratio [OR] = 4.215; 95% confidence interval [CI], 2.7-6.5), BP/NP pain (P < .001; OR = 3.1; 95% CI, 2.188-4.43), and LP/NP (P < .001; OR = 2.6, 95% CI, 1.8-3.6); Medicaid/uninsured payer status (P = .04; OR = 1.39; 95% CI, 1.01-1.93); and higher baseline ODI/NDI (P = .002; OR = 1.11; 95% CI, 1.04-1.19) and BP/NP scores (P = .002; OR = 1.03; 95% CI, 1.01-1.06) were the independent predictors of patient dissatisfaction at 12 months after surgery.
Patient satisfaction with outcome may accurately represent the effectiveness of surgical spine care in terms of 1-year improvement in pain and disability. However, healthcare stakeholders relying on satisfaction as a proxy of overall quality or effectiveness of care need to account for Medicaid/uninsured payer status and worse baseline pain and disability scores as confounders.
患者满意度指标正逐渐成为脊柱手术后医疗质量和费用报销的决定因素。识别可改善满意度的因素至关重要。
评估患者相关因素或患者报告的结局能否预测脊柱手术后的不满意情况。
对2年内接受退行性腰椎和颈椎疾病择期手术的患者进行前瞻性纵向登记。在基线和12个月随访时记录患者报告的结局、Oswestry功能障碍指数（ODI）/颈部功能障碍指数（NDI）以及背部/颈部（BP/NP）和腿部/手臂疼痛（LP/AP）的数字评分量表。使用先前公布的ODI最小临床重要差异值14.9%、NDI为17.3%、BP/NP为2.1/2.6、LP/AP为2.8/4.1。采用北美脊柱协会满意度问卷评估患者满意度。
共有1645例患者接受了脊柱择期手术（811例男性患者；年龄57±13岁）。83%的患者（1362例）报告术后12个月对结局满意。在多变量分析中，在控制一系列患者特定因素后，ODI/NDI未能达到最小临床重要差异（P<.001；优势比[OR]=4.215；95%置信区间[CI]，2.7 - 6.5）、BP/NP疼痛（P<.001；OR = 3.1；95%CI，2.188 - 4.43）以及LP/NP（P<.001；OR = 2.6，95%CI，1.8 - 3.6）；医疗补助/未参保支付者状态（P =.04；OR = 1.39；95%CI，1.01 - 1.93）；以及更高的基线ODI/NDI（P =.002；OR = 1.11；95%CI，1.04 - 1.19）和BP/NP评分（P =.002；OR = 1.03；95%CI，1.01 - 1.06）是术后12个月患者不满意的独立预测因素。
患者对结局的满意度在疼痛和功能障碍1年改善方面可能准确反映脊柱手术治疗的有效性。然而，将满意度作为医疗总体质量或有效性替代指标的医疗利益相关者需要将医疗补助/未参保支付者状态以及更差的基线疼痛和功能障碍评分作为混杂因素考虑在内。
