Department of Orthopaedic and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Department Orthopaedic Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
Spine J. 2017 Dec;17(12):1783-1793. doi: 10.1016/j.spinee.2017.05.027. Epub 2017 Sep 29.
Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported Oswestry Disability Index (ODI) scores at baseline and 12 months on satisfaction with outcomes following spine surgery is not well documented.
This study aimed to determine the impact of patient disability (ODI) scores at baseline and 12 months on satisfaction with outcomes following surgery.
Analysis of prospectively collected longitudinal web-based multicenter data.
Patients undergoing elective surgery for degenerative lumbar disease were entered into a prospective multicenter registry.
Primary outcome measures were ODI, North American Spine Society satisfaction (NASS) questionnaire.
Baseline and 12-month ODI scores were recorded. Satisfaction at 12 months after surgery was measured using NASS questionnaire. Multivariable proportional odds logistic regression analysis was conducted to determine the impact of baseline and 12-month ODI on satisfaction with outcomes.
Of the total 5,443 patients, 64% (n=3,460) were satisfied at a level where surgery met their expectations (NASS level 1) at 12 months after surgery. After adjusting for all baseline and surgery-specific variables, the 12-month ODI score had the highest impact (Wald χ=1,555, 86% of the total χ) on achieving satisfaction with outcomes compared with baseline ODI scores (Wald χ=93, 5% of the total χ). The level of satisfaction decreases with increasing 12-month ODI score. Greater change in ODI is required to achieve a better satisfaction level when the patient starts with a higher baseline ODI score.
Absolute 12-month ODI following surgery had a significant association on satisfaction with outcomes 12 months after surgery. Patients with higher baseline ODI required a larger change in ODI score to achieve satisfaction. No single measure can be used as a sole yardstick to measure quality of care after spine surgery. Satisfaction may be used in conjunction with baseline and 12-month ODI scores to provide an assessment of the quality of spine surgery provided in a patient centric fashion.
全面的护理质量评估包括患者报告的结果、护理安全以及患者满意度。患者报告的 Oswestry 功能障碍指数（ODI）基线和 12 个月时的评分对脊柱手术后结果满意度的影响尚未得到充分记录。
本研究旨在确定患者基线和 12 个月时的残疾（ODI）评分对手术治疗后结果满意度的影响。
前瞻性收集的纵向网络多中心数据的分析。
接受择期退行性腰椎疾病手术的患者被纳入前瞻性多中心登记处。
主要观察指标为 ODI、北美脊柱协会满意度问卷（NASS）。
记录基线和 12 个月时的 ODI 评分。术后 12 个月时使用 NASS 问卷测量患者对治疗效果的满意度。采用多变量比例优势逻辑回归分析确定基线和 12 个月时 ODI 对治疗效果满意度的影响。
在总共 5443 名患者中，64%（n=3460）在术后 12 个月时对手术结果表示满意（NASS 满意度等级 1）。在调整所有基线和手术特异性变量后，12 个月时的 ODI 评分对达到治疗效果满意度的影响最大（Wald χ=1，占总 χ 的 86%），其次是基线 ODI 评分（Wald χ=93，占总 χ 的 5%）。满意度随 12 个月 ODI 评分的增加而降低。当患者的基线 ODI 评分较高时，需要更大的 ODI 变化才能达到更好的满意度水平。
术后 12 个月的绝对 ODI 与术后 12 个月的治疗效果满意度显著相关。基线 ODI 较高的患者需要更大的 ODI 变化才能达到满意度。没有单一的指标可以作为衡量脊柱手术后护理质量的唯一标准。满意度可以与基线和 12 个月的 ODI 评分结合使用，从患者角度提供对脊柱手术质量的评估。
