Patient Satisfaction Following Lumbar Fusion Is Associated With Functional Status and Pain More Than the Attainment of Minimal Clinically Important Difference: Implications for Value-Based Medicine.

BACKGROUND

In an era of value-based medicine, patient-perceived benefit and satisfaction are of paramount importance. However, current metrics of success such as the minimal clinically important difference (MCID) do not always correlate with overall patient satisfaction. Therefore, the purpose of this study was to understand the relationships between self-reported pain, Oswestry Disability Index (ODI) scores, reaching the MCID, and overall patient satisfaction in patients undergoing elective lumbar fusions.

METHODS

A retrospective study including patients between the ages of 18 and 89 years old who underwent a 1- or 2-level elective lumbar fusion between June 2021 and June 2023. Patients were stratified using this overall level of satisfaction with their procedure. Differences in clinical metrics and patient-reported outcome scores among satisfaction levels were assessed, and predictive analytics were used to determine whether clinical metrics were associated with satisfaction.

RESULTS

A total of 343 patients were included in this study; 81% indicated they were satisfied with their overall outcomes. There were differences in both clinical metrics and patient-reported outcomes based on satisfaction level. Current pain and function were found to be independent predictors of satisfaction, while ODI scores and reaching MCID were not.

CLINICAL RELEVANCE

Relying on meeting statistically defined benchmarks of success, such as the MCID, may not provide an accurate depiction of procedural success or patient satisfaction, and additional clinically relevant benchmarks should also be assessed.

CONCLUSIONS

Pain and current function were significantly associated with patient satisfaction; therefore, these metrics may play a larger role in patient satisfaction and perceived benefit than assessment through the ODI alone.