Abstract
Patient-reported outcome measures (PROMs) have become an important aspect of quality control in modern healthcare. In this prospective observational study on 199 patients undergoing thoracolumbar stabilization surgery, we quantified preoperative expectations and PROMs at six and twelve months after surgery, and we investigated what constitutes patient satisfaction with the outcome. We used the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI). Preoperative expectations were high (expected ODI: 9 ± 13%; leg pain: 1.0 ± 1.4; back pain: 1.3 ± 1.5). Pain and disability improved substantially, but expectations were mostly unrealistic (ODI expectation fulfilled after six months: 28% of patients; back pain: 48%). However, satisfaction was high (70% at six months after surgery). Satisfied patients had significantly better pain and disability outcomes and higher rates of expectation fulfillment than non-satisfied patients. Patients undergoing revision stabilization had worse outcomes than all other diagnosis groups. Prior stabilization surgery was identified as an independent risk factor for dissatisfaction. There were no preoperative pain or disability levels that predicted dissatisfaction. The data presented in this study can provide benchmarks for diagnosis-specific PROM targets in thoracolumbar stabilization surgery. Future studies should investigate whether satisfaction can be influenced, e.g., by discussing realistic outcome targets with patients ahead of surgery.
Highlights
In modern healthcare delivery models, such as value-based healthcare, care providers are rewarded based on patient health outcomes
We found that outcomes are disease-specific: patients undergoing revision stabilization surgery, for example, have significantly worse outcomes than those with degenerative disease that are scheduled for primary stabilization
As expected, that the actual pain and disability outcome is of paramount importance for patient satisfaction, in accordance with a previous study on expectations and satisfaction in minimally invasive lumbar fusion surgery [21]
Summary
In modern healthcare delivery models, such as value-based healthcare, care providers are rewarded based on patient health outcomes. In orthopedic surgery and spinal surgery, patient satisfaction and other patient-reported outcome measures (PROMs) have come into focus as key indicators for quality assessment, and as a potential basis for reimbursement. To adequately assess individual PROMs in spinal surgery, realistic outcome targets have to be established for specific types of spinal disease and treatment. One has to identify the factors that drive patient satisfaction first in order to improve it. It is unclear, for example, to what extent pain relief and disability improvement contribute to satisfaction after spinal surgery [2]. Satisfaction has been closely related to Surgeries 2020, 1, 63–76; doi:10.3390/surgeries1020008 www.mdpi.com/journal/surgeries
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