Patient-Specific Factors Associated With Dissatisfaction After Elective Surgery for Degenerative Spine Diseases

Neurosurgery. 2015 Aug;77(2):157-63; discussion 163. doi: 10.1227/NEU.0000000000000768.

Abstract

Background: 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.

Objective: To evaluate whether patient-related factors or patient-reported outcomes could predict dissatisfaction after spine surgery.

Methods: 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.

Results: 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.

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Cervical Vertebrae / surgery
  • Disability Evaluation
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intervertebral Disc Degeneration / surgery*
  • Lumbar Vertebrae / surgery
  • Male
  • Medicaid
  • Medically Uninsured
  • Middle Aged
  • Neck Pain / etiology
  • Neurosurgical Procedures / adverse effects*
  • Neurosurgical Procedures / methods
  • Pain / epidemiology
  • Pain / etiology
  • Pain Measurement
  • Patient Satisfaction*
  • Prospective Studies
  • Socioeconomic Factors
  • Treatment Failure
  • Treatment Outcome
  • United States