Preoperative patient expectations and postoperative satisfaction following singlelevel unilateral biportal endoscopic lumbar discectomy: Are higher expectations associated with lower satisfaction?

Abstract

Objective: Unilateral biportal endoscopy (UBE) has gained prominence in the surgical treatment of lumbar disc herniation (LDH) because of its minimally invasive profile. How preoperative patient expectations align with postoperative satisfaction after UBE remains insufficiently characterized. The aim was to evaluate the relationship between preoperative expectations and 6-month postoperative satisfaction after single-level UBE discectomy, while also assessing perioperative safety and patient-reported outcomes.

Methods: Retrospective, single-center cohort of consecutive adults undergoing single-level UBE discectomy (September 2022-January 2024) performed by a single surgeon. Preoperative expectations were captured with an 8-item Likert-type survey (scaled 0-100). Outcomes at 6 months included visual analog scale (VAS) (back/leg), Oswestry Disability Index (ODI), a single-item satisfaction score (0-100), and patient acceptable symptom state (PASS) derived by anchor-based receiver operating characteristic (ROC) analysis for ODI; a sensitivity analysis tested the fixed threshold ODI ≤25. Group comparisons used ANOVA/Kruskal-Wallis with Tukey post-hoc as appropriate. Associations were examined using Pearson correlation and restricted multivariable regression models adjusted for clinically prespecified covariates.

Results: During the study period, 102 patients were screened; 73 were eligible after exclusions (n = 29). Six-month outcome data were available for 68/73 patients (5 lost to follow-up/incomplete records). The analyzed cohort had a mean age of 44.7 } 9.8 years and 55.9% were male. Perioperative metrics reflected a favorable minimally invasive profile (operative time 96.8 } 11.7 minutes; estimated blood loss 56.3 } 24.1 mL; length of stay 1.8 Å} 0.9 days; complications 5.9%, no reoperations). Pain and disability improved substantially from baseline to 6 months (VAS 7.6 } 1.1 to 1.9 } 0.8; Δ = -5.7 } 1.3; P < .001; ODI 56.3 } 8.7 to 17.5 } 6.1; Δ = -38.8 } 9.2; P < .001). The mean expectation rating score was 76.5 } 14.8 and satisfaction 82.1 } 12.4. Higher preoperative expectations correlated with lower satisfaction (r = -0.37; P = .02). Satisfaction differed across expectation strata (P < .01), with the highest scores in the moderate group and lowest scores in the high group; post-hoc significance was observed for moderate versus high expectations (Tukey, P = .004). Patient acceptable symptom state analysis identified a cohort-specific ODI threshold with high discriminative ability; overall PASS rates were high and did not differ across expectation groups. In multivariable models, higher expectations were independently associated with lower satisfaction but not with change in VAS/ODI or achievement of PASS.

Conclusion: Single-level UBE discectomy yields robust improvements in pain and function with low morbidity. Higher preoperative expectation scores were independently associated with lower postoperative satisfaction, despite comparable clinical gains and PASS attainment. Satisfaction was highest in the moderate-expectation group and lowest in the high-expectation group, with pairwise significance observed only between the moderate- and high-expectation groups. These findings suggest that satisfaction after UBE discectomy is related not only to objective clinical improvement but also to expectation-outcome alignment.   Cite this article as: Bayram Y, Karataş ME, Uzunlu İ, Bulum YE. Preoperative patient expectations and postoperative satisfaction following singlelevel unilateral biportal endoscopic lumbar discectomy: Are higher expectations associated with lower satisfaction?. Acta Orthop Traumatol Turc., 2026; 60(4), 0799, doi: 10.5152/j.aott.2026.25799.