Abstract
BACKGROUND CONTEXT
Preoperative expectations influence postoperative outcomes. Patients with lumbar degenerative
spondylolisthesis have especially high expectations of pain relief and overall functional
well-being compared to patients with lumbar stenosis.
PURPOSE
The primary objective was to analyze preoperative expectations of lumbar DS patients
with respect to the type of surgery proposed (decompression vs decompression and fusion).
Secondarily, we aimed to assess the associations between preoperative expectations
and patient and clinical factors as well as postoperative expectations fulfillment.
STUDY DESIGN/SETTING
Patients were prospectively enrolled in a multicenter, prospective cohort study evaluating
the assessment and management of degenerative spondylolisthesis utilizing the infrastructure
of the Canadian Spine Outcomes and Research Network (CSORN) surgical registry.
PATIENT SAMPLE
Patients with a diagnosis of degenerative spondylolisthesis with symptoms of neurogenic
claudication or radiculopathy with or without back pain, unresponsive to nonoperative
management over at least 3 months were included. Patients who underwent decompression,
decompression and posterolateral fusion or decompression and interbody fusion at Canadian
spine centers between January 2015 and September 2021 were included.
OUTCOME MEASURES
The North American Spine Society Lumbar Spine Questionnaire was utilized for expectations
measurement. The expectation questionnaire was completed following consent and before
surgery and at 1 year.
METHODS
Expectations for pain relief and improvements in overall functional well-being were
rated on a scale of 0 to 100. Preoperative expectation in terms of pain relief and functional well-being score were calculated. Multivariate linear regression was used to evaluate the association
between expected preoperative patient factors and pain relief and functional well-being.
The factors associated with the most important expectation were evaluated using multivariable
multinomial logistic regression.
RESULTS
Three hundred fifty-two patients were included with 100 patients undergoing decompression
and 252 patients also undergoing fusion. The seven items of preoperative expectations
did not differ between the procedure groups nor did expected change. The mean pain relief and overall functional well-being expectation scores did not significantly differ between procedures.
Higher expectations were associated with having more comorbidities [β=-2.0 (SE 0.8),
p=.020], being physically active [β=8.4 (SE 3.2), p=.010] and having more leg pain
[β=1.6 (SE 0.7), p=.015]. Better perceived physical health measured by SF12 PCS was
associated with lower expectation of pain relief [β= -0.4 (SE 0.2), p=.039] and functional
well-being [β=-0.84 (SE 0.2), p=.001]. Better perceived mental health measured by
SF12 MCS was associated with lower expectation of functional well-being [β=-0.8 (SE
0.2), p=.001].
Postoperative expectations fulfillment did not differ between procedures.
CONCLUSION
Preoperative expectations in terms of pain relief and functional well-being were similar
between the two most common procedures performed, decompression ± fusion. Secondarily,
higher preoperative expectations were associated with greater pain, disability and
being physically active. Expectations fulfillment did not differ between procedures.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Spine JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Interventions for providers to promote a patient-centred approach in clinical consultations.Cochrane Database Syst Rev. 2001; CD003267https://doi.org/10.1002/14651858.CD003267
- Exploring the expectation-actuality discrepancy: a systematic review of the impact of preoperative expectations on satisfaction and patient reported outcomes in spinal surgery.Neurosurg Rev. 2018; 41: 19-30https://doi.org/10.1007/s10143-016-0720-0
- Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study.Spine (Phila Pa 1976). 2012; 37: E103-E108https://doi.org/10.1097/BRS.0b013e3182245c1f
- The powerful placebo.J Am Med Assoc. 1955; 159: 1602-1606https://doi.org/10.1001/jama.1955.02960340022006
- Patients’ expectations predict surgery outcomes: a meta-analysis.Int J Behav Med. 2016; 23: 49-62https://doi.org/10.1007/s12529-015-9500-4
- Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes.CMAJ. 2001; 165: 174-179
- Preoperative expectations of pain and recovery in relation to postoperative disappointment in patients undergoing lumbar surgery.Med Care. 1999; 37: 149-156https://doi.org/10.1097/00005650-199902000-00005
- Fulfillment of patients’ expectations of lumbar and cervical spine surgery.Spine J. 2016; 16: 1167-1174https://doi.org/10.1016/j.spinee.2016.04.011
- Do patient expectations of spinal surgery relate to functional outcome?.Clin Orthop Relat Res. 2008; 466: 1154-1161https://doi.org/10.1007/s11999-008-0194-7
- Patient preferences and expectations for care: determinants in patients with lumbar intervertebral disc herniation.Spine (Phila Pa 1976). 2008; 33: 2663-2668https://doi.org/10.1097/BRS.0b013e31818cb0db
- Patients’ expectations of spine surgery for degenerative conditions: results from the Canadian Spine Outcomes and Research Network (CSORN).Spine J. 2020; 20: 399-408https://doi.org/10.1016/j.spinee.2019.10.001
- The impact of pathoanatomical diagnosis on elective spine surgery patient expectations: a Canadian Spine Outcomes and Research Network study.J Neurosurg Spine. 2021; : 1-8https://doi.org/10.3171/2020.11.SPINE201490
- Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms.Spine J. 2018; 18: 606-613https://doi.org/10.1016/j.spinee.2017.08.260
- Patients’ expectations of cervical spine surgery.Spine (Phila Pa 1976). 2014; 39: 1157-1162https://doi.org/10.1097/BRS.0000000000000349
- Patients’ expectations of lumbar spine surgery.Eur Spine J. 2015; 24: 2362-2369https://doi.org/10.1007/s00586-014-3597-z
- The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests.Spine (Phila Pa 1976). 1996; 21: 741-749https://doi.org/10.1097/00007632-199603150-00017
- Responsiveness of the numeric pain rating scale in patients with low back pain.Spine (Phila Pa 1976). 2005; 30: 1331-1334https://doi.org/10.1097/01.brs.0000164099.92112.29
- The Oswestry low back pain disability questionnaire.Physiotherapy. 1980; 66: 271-273
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613https://doi.org/10.1046/j.1525-1497.2001.016009606.x
- A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233https://doi.org/10.1097/00005650-199603000-00003
- Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process.Eur Spine J. 2015; 24: 339-347https://doi.org/10.1007/s00586-014-3441-5
- Patient preferences for treatment of low back pain-a discrete choice experiment.Value Health. 2014; 17: 390-396https://doi.org/10.1016/j.jval.2014.01.005
- Predictors of treatment choice in lumbar spinal stenosis: a spine patient outcomes research trial study.Spine (Phila Pa 1976). 2012; 37: 1702-1707https://doi.org/10.1097/BRS.0b013e3182541955
- Factors affecting decision making process on spine surgery: patients’ perspective.Pak J Neurol Surg. 2020; 24: 143-148https://doi.org/10.36552/pjns.v24i2.445
- A comparison of patient and surgeon expectations of spine surgical outcomes.Global Spine J. 2021; 11: 331-337https://doi.org/10.1177/2192568220907603
- [Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty].Beijing Da Xue Xue Bao Yi Xue Ban. 2022; 54: 170-176
- Patient factors associated with higher expectations from foot and ankle surgery.Foot Ankle Int. 2017; 38: 472-478https://doi.org/10.1177/1071100717690807
- Patient expectations and satisfaction in orthopaedic surgery: a review of the literature.J Clin Orthop Trauma. 2019; 10: 755-760https://doi.org/10.1016/j.jcot.2018.08.008
- Great expectations: really the novel predictor of outcome after spinal surgery?.Spine (Phila Pa 1976). 2009; 34: 1590-1599https://doi.org/10.1097/BRS.0b013e31819fcd52
- Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.Clin Neurol Neurosurg. 2017; 157: 11-16https://doi.org/10.1016/j.clineuro.2017.03.007
- Sources of patients’ expectations of lumbar surgery.Spine (Phila Pa 1976). 2019; 44: 318-324https://doi.org/10.1097/BRS.0000000000002830
Article info
Publication history
Published online: February 08, 2023
Accepted:
January 26,
2023
Received in revised form:
December 1,
2022
Received:
October 4,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: CD: Nothing to disclose. JU: Nothing to disclose. CSB: Nothing to disclose. TA: Speaking and/or Teaching Arrangements: Stryker (B), Depuy (A). RC-M: Grants: NASS Translational award (F), AOSpine Discovery and Innovation Award (F), Canadian Orthopaedic Foundation (C), AOSpine North America (B). ND: Nothing to disclose. MD: Consulting: Medtronic (Unknown number of options, <1% ownership), Trips/Travel: Medtronic/ AO Spine (costs of travel). AG: Nothing to disclose. BKK: Nothing to disclose. SP: Fellowship Support: AO SPine (Money paid to institution). RR: Royalties: Medtronic (E). JTS: Nothing to disclose. CH: Nothing to disclose. MSM: Nothing to disclose. CGF: Royalties: Medtronic(Unknown number of options, <1% ownership); Consulting: Medtronic, Nuvasive (Unknown number of options, <1% ownership); Grants: OREF(Unknown number of options, <1% ownership); Fellowship Support: AO Spine, Medtronic, Depuy Synthes (Unknown number of options, <1% ownership).
Institutional review board approval has been obtained.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
