Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
Neurosurgery. 2020 May 1;86(5):736-741. doi: 10.1093/neuros/nyz231.
Modern healthcare reforms focus on identifying and measuring the quality and value of care. Patient satisfaction is particularly important in the management of degenerative cervical radiculopathy (DCR) since it leads to significant neck pain and disability primarily affecting the patients' quality of life.
To determine the association of baseline and 12-mo Neck Disability Index (NDI) with patient satisfaction after elective surgery for DCR.
The Quality Outcomes Database cervical module was queried for patients who underwent elective surgery for DCR. A multivariable proportional odds regression model was fitted with 12-mo satisfaction as the outcome. The covariates for this model included patients' demographics, surgical characteristics, and baseline and 12-mo patient reported outcomes (PROs). Wald-statistics were calculated to determine the relative importance of each independent variable for 12-mo patient satisfaction.
The analysis included 2206 patients who underwent elective surgery for DCR. In multivariable analysis, after adjusting for baseline and surgery specific variables, the 12-mo NDI score showed the highest association with 12-mo satisfaction (Waldχ2-df = 99.17, 58.1% of total χ2). The level of satisfaction increases with decrease in 12-mo NDI score regardless of the baseline NDI score.
Our study identifies 12-mo NDI score as a very influential driver of 12-mo patient satisfaction after surgery for DCR. In addition, there are lesser contributions from other 12-mo PROs, baseline Numeric Rating Scale for arm pain and American Society of Anesthesiologists (ASA) grade. The baseline level of disability was found to be irrelevant to patients. They seemed to only value their current level of disability, compared to baseline, in rating satisfaction with surgical outcome.
现代医疗改革的重点是确定和衡量医疗保健的质量和价值。患者满意度在退行性颈椎神经根病（DCR）的管理中尤为重要，因为它主要导致显著的颈部疼痛和残疾，主要影响患者的生活质量。
确定基线和 12 个月颈痛残疾指数（NDI）与 DCR 选择性手术后患者满意度的关系。
查询颈椎模块的质量结果数据库，以确定接受 DCR 选择性手术的患者。将 12 个月满意度作为结果拟合多变量比例优势回归模型。该模型的协变量包括患者的人口统计学、手术特征以及基线和 12 个月的患者报告结果（PRO）。通过 Wald 统计量确定每个自变量对 12 个月患者满意度的相对重要性。
该分析包括 2206 例接受 DCR 选择性手术的患者。在多变量分析中，在调整基线和手术特定变量后，12 个月 NDI 评分与 12 个月满意度的相关性最高（Wald χ 2 -df = 99.17，总 χ 2 的 58.1%）。无论基线 NDI 评分如何，12 个月 NDI 评分越低，满意度水平越高。
我们的研究确定 12 个月 NDI 评分是 DCR 手术后 12 个月患者满意度的一个非常重要的驱动因素。此外，其他 12 个月 PROs、基线手臂疼痛数字评分和美国麻醉医师协会（ASA）分级的贡献较小。基线残疾水平与患者无关。与基线相比，他们似乎只重视当前的残疾水平，以评估对手术结果的满意度。
