144. Concordance between patients’ and surgeons’ expectations of cervical spine surgery

Abstract

BACKGROUND CONTEXT Patients undergo cervical spine surgery because they expect improvement in physical and psychological symptoms and function. Patients and surgeons need to share an understanding of what are possible, probable and realistic expectations so they can work toward the same goals. PURPOSE To compare concordance (agreement) within the patient-surgeon pair regarding expectations of cervical spine surgery. STUDY DESIGN/SETTING Cross-sectional, tertiary spine center. PATIENT SAMPLE This study included106 patients scheduled for cervical spine surgery and their surgeons. OUTCOME MEASURES Hospital for Special Surgery Cervical Spine Surgery Expectations Survey. METHODS Patients scheduled for cervical spine surgery were recruited from the practices of 5 spine surgeons and interviewed in person several days before surgery with several patient-centered questionnaires including the Neck Disability Index (NDI) (score range 0-100, higher is worse), the PHQ8 for depressive symptoms (score range 0-24, ≥10 is a positive screen for depression), and the valid Cervical Spine Surgery Expectations Survey. The 20-item Expectations Survey addresses symptoms, physical function, and psychological well-being, and asks how much improvement is expected with response options of “complete” (=4 points), “a lot” (=3 points), “a moderate amount” (=2 points), “a little” (=1 point), or “no improvement/this expectation does not apply to me” (=0 points). An overall score is calculated as the sum of all responses (range 0-100, higher is greater expectations). Before surgery, surgeons completed an identical survey asking them to rate how much improvement they expected for each item for each of their patients. The surgeon's survey is scored similarly to generate an overall score (range 0-100). Concordance between scores for each patient-surgeon pair was measured with the intraclass correlation coefficient (ICC) for continuous data (range 0-1.0: 0-.20 poor; .21-.40 fair; .41-60 moderate; .61-.80 good; .81-1.0 excellent agreement). RESULTS Patients completed the Expectations Survey a mean of 9 days before surgery, mean age was 57 years, 50% were women, mean NDI score was 42±20, 26% had a positive screen for depression, 32% had a diagnosis of myelopathy, and 68% had a diagnosis of radiculopathy. The 5 surgeons were age 41-63 years, in practice for 8-31 years, and all had completed a spine fellowship. The mean Expectations Survey score was 65±22 for patients and 57±19 for surgeons (p CONCLUSIONS Overall concordance between patients’ and surgeons’ expectations was moderate, but varied from fair to excellent based on major demographic, diagnostic, and clinical characteristics. Because patients and surgeons may not be aware of differences in expectations, discussions about expectations should be part of comprehensive preoperative evaluations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.