After spinal surgery, good indicator of success is patient satisfaction
A study published by Wolters Kluwer, in the August issue of Neurosurgery, official journal of the Congress of Neurological Surgeons reported that patient satisfaction ratings after surgery for spinal degenerative disease especially in terms of reduced pain and disability are a good indicator of the procedure's effectiveness.
According to the new research by Dr. Clinton J. Devin of Vanderbilt University Medical Center, Nashville, and colleagues, effectiveness of surgical spine care in terms of one-year improvement in pain and disability can be precisely represented by the patient satisfaction with outcome. However, more research is required to elucidate the impact of insurance status and initial severity scores on the outcomes of surgery for degenerative spine disease.
Analysis of one-year follow-up data on 1,645 patients undergoing surgery for degenerative disease of the upper (cervical) and lower (lumbar) spine was done. Patients were evaluated for disability and neck, back, arm and leg pain, before and one year after surgery.
Eighty three percent of patients were satisfied with the outcomes after one year based on a spinal surgery satisfaction scale. The researchers wanted to see whether any of the factors evaluated before surgery could predict whether patients would be satisfied or dissatisfied with their outcomes.
Many specific predictors were identified after adjustment for a wide array of patient-specific factors. Patients who didn't have at least a 15% improvement on a standard disability rating scale considered to be the "minimal clinically important difference" and were four times more likely to be dissatisfied with their results.
Patients in which, minimal clinically important differences in pain scores was not achieved were about 3 times more likely to be dissatisfied with outcomes. Patients who were on Medicaid or uninsured also had lower satisfaction rates.
The chances to achieve clinically meaningful improvement and satisfaction rates were expected to be less in patients with depression or anxiety before surgery. However, after initial pain and disability scores alteration, these mental health factors were not important predictors.
According to Dr. Devin and coauthors, patient satisfaction scores are increasingly used as measures of the quality of medical care and as a determinant of reimbursement for care provided. Recognizing factors that can be modified and improve satisfaction is of great importance.
The new study showed that patient satisfaction ratings after surgery for spinal degenerative disease lined up well with the level of improvement in pain and disability achieved. Researchers believed that surgical ineffectiveness was a strong independent predictor of dissatisfaction.
But the results also showed a major impact of initial pain and disability, suggesting that patients with more severe spinal degenerative disease are less likely to be satisfied with the results of surgery. Insurance status also seems to have an impact.
Dr. Devin and coauthors believed that this study may provide tools to help recognize individuals at risk of dissatisfaction and to improve the delivery of spine care. They concluded that individualizing the patient preoperative counseling on the basis of these patient-specific factors can improve patient satisfaction with outcomes.