272. Greater disability associated with patients’ unrealistic expectations of lumbar surgery compared to surgeons’ expectations

Abstract

BACKGROUND CONTEXT Concordance, or agreement, between patients and surgeons regarding expectations of lumbar surgery is a preoperative goal. Understanding what demographic and clinical characteristics contribute to differences in expectations, particularly unrealistically high expectations, would help direct preoperative communication. PURPOSE To compare concordance within the patient-surgeon pair regarding expectations of surgery, and to assess differences in expectations by demographic and clinical characteristics STUDY DESIGN/SETTING Cross-sectional, tertiary spine center. PATIENT SAMPLE A total of 402 lumbar surgery patient-surgeon pairs. OUTCOME MEASURES HSS Lumbar Spine Surgery Expectations Survey. METHODS Patients of 5 spine surgeons were interviewed preoperatively and completed the ODI and the valid 20-item Expectations Survey. The Survey asks how much improvement is expected for each item with response options of complete to no improvement, and a total and 4 domain scores (ie, personal activities, daily function, psychological well-being and skeletal function) are generated (range 0-100, higher is greater expectations). Surgeons completed an identical survey asking them to rate expected improvement for each item for each patient, yielding similar 0-100 total and domain scores. Concordance within the patient-surgeon pair was measured with the intraclass correlation coefficient (ICC) (range 0 [agreement no better than chance] to 1 [perfect agreement]). Differences between patients’ and surgeons’ total and domain scores were then assessed in multivariable models. RESULTS Mean age was 55, 55% were men, 21% were self-described as non-white race/ethnicity, 79% had degenerative conditions, and mean ODI score was 53 (range 4-84). Patients and surgeons independently completed the Survey within 10 days preoperatively. The mean total survey score was 73±19 for patients, 57±16 for surgeons (p CONCLUSIONS There was fair agreement between patients and surgeons regarding expectations with patients having greater expectations, especially if they were more disabled. Although it seems logical that patients with the most disability would have the most to expect, the essential issue is whether such high expectations (ie, complete improvement) are realistic; according to surgeons, a lot/moderate improvement is more appropriate. Thus preoperative discussions should not be centered on what items to expect, but instead should emphasis how much improvement to expect for each item. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.