2012년 10월 6일 토요일

Relationship Between Preoperative Expectations, Satisfaction, and Functional Outcomes in Patients Undergoing Lumbar and Cervical Spine Surgery

Health Services Research
Spine 2012;37:E103–E108

Title:
Relationship Between Preoperative Expectations, Satisfaction, and Functional Outcomes in Patients Undergoing Lumbar and Cervical Spine Surgery

Authors
Alexandra Soroceanu
Alexander Ching
William Abdu
Kevin McGuire

Study Design.
Analysis of prospectively collected multicenter data.

Objective.
To explore the relationship between preoperative expectations and postoperative outcomes and satisfaction in lumbar and cervical spine surgery

Summary of Background Data.
1. The most common health problems, back pain, leading to the utilization of health care resources, work loss, and sick benefits.

2. Patient expectations influence post treatment outcomes, both surgical and nonsurgical.

3. Few research on the importance of preoperative expectations in spine surgery.

4. Existing studiesà technical aspects of interventions and functional outcomes but fail to take into account patient expectations.

5. Hypothesized that expectations dramatically affect spine patient satisfaction independent of functional outcomes.

Methods.
1. Patient-entered data (lumbar and cervical surgery) from 2 study centers

2. Inclusion
   à Operative intervention (decompression with or without fusion), 3mon f/u period

3. Preoperative expectations
Musculoskeletal Outcomes Data Evaluation and Management System’s expectation survey
  
4. Postoperative satisfaction and fulfillment of expectations
Musculoskeletal Outcomes Data Evaluation and Management System’s satisfaction survey

5. Postoperative functional outcomes
Oswestry Disability Index and 36-item short form health survey

6. Statistics
Ordinal logistic regression multivariate modeling for predictors of post-op satisfaction
Linear regression multivariate modeling for predictors of functional outcomes

Results.
1. Greater fulfillment of expectations
à Higher postoperative satisfaction
à Associated with better functional outcomes

2. Higher preoperative expectations
à Decreased postsurgical satisfaction
à Associated with improved functional outcomes

3. Higher postoperative satisfaction
à Associated with improved functional outcomes and vice versa

4. Type of surgery also influenced satisfaction and function, with cervical patients being less satisfied but having better functional outcomes than lumbar patients.

Conclusion.
1. This study showed that more than functional outcomes matter; preoperative expectations and fulfillment of expectations influence post-op satisfaction in patients undergoing lumbar and cervical spine surgery.

2. This underlines the importance of taking pre-op expectations into account to obtain an informed choice on the basis of the patient’s preferences.

Key Points
1. Higher pre-op expectations were associated with lower post-op satisfaction but may lead to better functional outcomes.

2. Fulfillment of pre-op expectations was associated with better post surgical functional outcomes and satisfaction.

3. Cervical spine patients had better functional outcomes post intervention but were less satisfied with the outcomes of the surgery.

4. After adjusting for preoperative expectations, higher functional outcomes were associated with higher post-op satisfaction, and vice versa .

5. Pre-op expectations regarding pain relief were the most likely to be met after the procedure. Expectations regarding return to work and ability to exercise were the least likely to be met after the procedure.

의사도 환자도 수술 결과를 현실성 있게 예측, 공유해야 하고 , 환자가 현실성 없는 기대를 하고 있다면 그것을 반드시 바로 잡아줘야 같다.


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