212. Giving patients the info they want: practical answers to FAQs for shared decision-making in ASD surgery

Abstract

BACKGROUND CONTEXT The shared decision-making (SDM) process is an opportunity to deliver answers to frequently asked questions (FAQs) in adult spinal deformity (ASD) surgery. PURPOSE Our goal was to present a concise list of answers to these FAQs to aid in SDM counseling. STUDY DESIGN/SETTING Retrospective analysis of a prospective multi-center ASD database. PATIENT SAMPLE Adult spinal deformity patients undergoing surgical correction enrolled into a prospective, multicenter surgical database from 2008-2016. OUTCOME MEASURES Health related quality of life (HRQOL) outcome measures were collected such as Oswestry Disability Index (ODI), SF-36 PCS, and SF-36 MCS. METHODS Adult patients undergoing ≥ 5 level fusion with minimum 2-year follow up were included. We purposely included all deformity types (heterogeneity) to provide general applicability. We compiled a list of FAQs by patients undergoing ASD surgery and utilized a retrospective analysis to provide answers. All responses are reported as either means or reaching minimal clinically important difference (MCID) at the 2-year follow-up interval. RESULTS Out of 689 ASD patients eligible for 2-year follow-up, 521 (76%) had complete follow-up. The majority were female (77%) with mean age of 58.5 years and BMI of 27.5. Mean levels fused were 11.3 with 52% being primary vs 48% revision surgeries. Will my pain improve? Back (7.2 to 3.6) and leg (4.7 to 2.6) pain were both reduced by ∼50%. Will my activity level improve? A total of 63.9% reached MCID for SRS-22r activity. Will I feel better about myself? A total of 71.2% reached MCID for SRS-22r appearance. Is there a chance I'm worse? A total of 4.1% of patients were worse (ODI). What is the likelihood I have a complication? A total of 52.9% of patients have at least 1 complication and 29.6% have a major complication. Will I need another surgery? A total of 29.6% of patients have a reoperation within 2 years. Will I regret having surgery? A total of 32% would not choose the same treatment. Will I get a blood transfusion? A total of 79.1% of patients receive a blood transfusion. How long will I stay in the hospital? Study showed 9.9 days. Will I have to go to the ICU? A total of 79.1% of patients require an ICU stay. Will I be able to return to work? A total of 71% returned to full-time work at 2 years. Will I be taller after surgery? Yes, 1.4cm was the average CONCLUSIONS The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.