270. Engaged patients are more likely to be satisfied at one year following adult spinal deformity surgery

Abstract

BACKGROUND CONTEXT Engaged patients are those who believe taking an active role in their care is important, possess the knowledge to manage their condition, and have the confidence to make necessary behavioral changes. Following surgical treatment of adult spinal deformity (ASD), rehabilitation is an important component of recovery. Successful delivery of rehabilitative care involves a great degree of participation and effort on the part of patients. We hypothesize that patients who are more engaged in their care will experience a better recovery course that will be express through higher levels of patient satisfaction - an important metric of quality patient care. PURPOSE To identify the association between levels of preoperative patient engagement and postoperative satisfaction among ASD patients. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 90 ASD patients (>5 levels fused) at a multiprovider, single academic institution. OUTCOME MEASURES Our primary outcome was satisfaction with the results of surgical treatment, measured by the North American Spine Society (NASS) Patient Satisfaction Index. METHODS Preoperative engagement was measured using the Patient Activation Measure (PAM) score (stages 1-4) and postoperative satisfaction was measured using the NASS Patient Satisfaction Index at 1-year following surgery (satisfied vs not satisfied). Using binary logistic regression, we compared the likelihood of being satisfied with surgery across levels of patient activation after controlling for age, gender, race, education, income and marital status. Significance was set at 0.05. RESULTS A total of 90 patients were studied. Mean age was 61 ± 11 years old, 71% female. Patients had a median of 9 levels fused. Prior to surgery, 8 (8.9%) of patients were categorized as being PAM stage 1 (lowest score), 13 (14%) stage 2, 20 (22%) stage 3 and 49 (54%) stage 4 (highest score). 77 (86%) of patients were satisfied at 1-year. At 1-year, patients had significantly greater odds of satisfaction with PAM stage 3 (OR 16.2, 95% CI: 1.02 – 258.8) or 4 (OR 11.7, 95% CI: 1.4 – 97.1); however, there was no significantly greater odds of being satisfied with higher stages of preoperative activation at 3-months and 6-months following surgery (p CONCLUSIONS Patients with higher PAM scores have significantly greater odds of satisfaction at 1-year, while the PAM does not predict satisfaction at 6-months – suggesting that engagement becomes important in longer-term postoperative recovery. Clinicians may consider implementing previously proven techniques to increase patient activation in ASD patients in whom surgery is being considered. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.