Preoperative determinants of postoperative expectation fulfillment following elective lumbar spine surgery: an observational study from the Canadian Spine Outcome Research Network (CSORN).

Abstract

Background context: Preoperative patient factors determining expectation fulfillment from elective lumbar surgeries are poorly defined.

Purpose: To identify preoperative factors associated with the levels of expectation fulfillment following elective lumbar spine surgery.

Study design/ setting: This retrospective cohort study used the Canadian Spine Outcome Research Network (CSORN) registry data with participants enrolled between January 2015 and December 2020. The registry prospectively enrolled surgical patients to treat spinal disorders from twenty-three sites. Participating patients completed preoperative and follow-up questionnaires, including information on surgery expectations. Patients recorded their levels of expectation fulfillment on a Likert scale of 1-5, with responses ranging from Completely met (5) to Not applicable (1) in seven expectation dimensions.

Patient sample: Consecutive patients with four lumbar conditions (spinal stenosis, disc herniation, degenerative disc disease, or degenerative spondylolisthesis) and those with complete one-year follow-up questionnaires were included. Patients treated for thoracic or cervical pathologies and non-elective lumbar conditions were excluded. A total of 5389 patients who underwent surgery and completed one-year follow-up questionnaires out of 6971 eligible patients were included. Patients' socio-demographics, lifestyle, health status, and clinical factors were examined.

Outcome measures: The primary outcome was the association between expectation fulfillment and preoperative patient factors.

Methods: Patient factors were described for the expectation fulfillment categories using descriptive statistics. Bivariable and multivariable associations between patient factors and expectation fulfillment were estimated with ordinal logistic regression models. Point estimates represented as odd ratios, and 95% CIs were reported.

Results: The mean age of the participants was 59.5 years, with 49.8% (2683) of them being women. Unmet expectations ranged from 6.7% to 25.7%, with improvement in general physical capacity being the most important expectation fulfilled from surgery for 20% of patients. Factors such as longer symptom duration (OR: 0.74; 95% CI: 0.63-0.86), previous lumbar spine surgery (OR: 0.63; 95% CI: 0.46, 0.89), and reoperations (OR: 0.36; 95% CI: 0.2, 0.63) were associated with higher unmet expectations in the leg pain reduction dimension. Similar results were noted across all other expectation dimensions.

Conclusion: Utilizing information on the preoperative factors in presurgical consultations can improve patient satisfaction and expectations from surgery.