Predictors of Patient Satisfaction Following One- or Two-Level Anterior Cervical Discectomy and Fusion: Insights From the Quality Outcomes Database

Abstract

Abstract INTRODUCTION Patient satisfaction with the outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. There is a lack of nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery. The aim of this study was to decipher the impact of patient, practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF). METHODS We queried the Quality Outcome Database for patients undergoing 1 to 2 level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed adjusting for baseline patient characteristics, practice ID and surgeon ID characteristics as fixed effects. RESULTS A total of 4148 patients (median age 54 yr, 48% males) with complete 12-mo NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that “surgery met their expectations” (n = 2803), while 20% “did not improve as much as they had hoped but they would undergo the same operation for the same results” (n = 836). After adjusting for a multitude of patient specific as well as hospital and surgeon related factors, we found baseline NDI score, region of hospital, patient race, insurance status, symptom duration, and worker's compensation to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index = 0.66, overfitting-corrected = 0.64). CONCLUSION Our results found baseline NDI score, patient race, insurance status, symptom duration, worker's compensation as well as region of hospital to be the most important predictors of long-term patient satisfaction after a 1 to 2 level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with the patients on setting treatment goals and realistic expectations.