Chu Kwan William, Ailon Tamir, Dea Nicolas, Evaniew Nathan, Rampersaud Raja, Jacobs W Bradley, Paquet Jérome, Wilson Jefferson R, Hall Hamilton, Bailey Christopher S, Weber Michael H, Nataraj Andrew, Cadotte David W, Phan Philippe, Christie Sean D, Fisher Charles G, Singh Supriya, Manson Neil, Thomas Kenneth C, Toor Jay, Soroceanu Alex, McIntosh Greg, Charest-Morin Raphaële
Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Spine J. 2025 Feb;25(2):265-275. doi: 10.1016/j.spinee.2024.09.024. Epub 2024 Sep 26.
Healthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established.
Our primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM.
This is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN).
Patients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021.
Data analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale.
Multivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups.
Six hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, -3%, -10%, -14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI=0.81-0.90). No patient demographic or surgical factors influenced satisfaction.
Improvement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.
医疗保健报销正朝着基于价值的模式发展，该模式与患者满意度相互交织且强调患者满意度。此前尚未确定与退行性颈椎脊髓病（DCM）手术后满意度相关的因素。
我们的主要目标是确定DCM手术治疗后3个月和12个月时的满意度及满意度预测因素。
这是一项在加拿大脊柱结局与研究网络（CSORN）内进行的前瞻性队列研究。
研究中的患者为接受DCM手术治疗且于2015年至2021年期间在CSORN内完成3个月和12个月随访的患者。
分析的数据包括患者人口统计学资料、手术变量、患者报告结局（NDI、NRS-NP、NRS-AP、SF-12-MCS、SF-12-PCS、ED-5Q、PHQ-8）、日本骨科学会脊髓型颈椎病评分（MJO A）以及李克特量表上的自我报告满意度。
进行多变量回归分析以确定与满意度相关的显著因素，处理多重共线性并确保预测准确性。此过程分别针对3个月和12个月的随访进行。
纳入663例患者，平均年龄60岁，MJO A评分（轻度、中度、重度）分布均匀。在3个月和12个月随访时，满意度分别为86%和82%。在12个月时，逻辑回归显示，MJO A、NDI、NRS-NP、NRS-AP、SF-12-MCS、SF-12-PCS从基线到12个月每变化1分，满意的几率分别变化+24%、-3%、-10%、-14%、+3%和+12%。从基线到12个月，ED-5Q每增加0.1分，满意度增加11倍。在基线时，SF-12-MCS每增加1分，满意的几率增加7%。在3个月时，所有患者报告结局（除NRS-AP变化和基线SF-12-MCS外）均能预测满意度。所有逻辑回归分析均显示出优异的预测准确性，12个月时最高曲线下面积（AUC）为0.86（95%CI = 0.81 - 0.90）。没有患者人口统计学或手术因素影响满意度。
患者报告结局和MJO A的改善与DCM手术后的患者满意度密切相关。与12个月满意度相关的唯一基线患者报告结局是SF-12-MCS。没有可改变的患者基线特征或手术变量与满意度相关。
