54. How much change in Oswestry Disability Index is necessary to make your patient satisfied after lumbar surgery?

BACKGROUND CONTEXT

Evaluating the overall quality of care involves considering patient-reported outcomes. While in theory, postoperative functional improvement, as indicated by the Oswestry disability index (ODI), should result in postoperative patient satisfaction, the exact correlation has not been consistently evidenced in the literature. This study seeks to demonstrate the extent of ODI improvement required for achieving patient satisfaction two years post elective lumbar surgery.

PURPOSE

To evaluate the association between ODI improvement and patient reported satisfaction and to define ODI cut-off values indicative for patient satisfaction after elective lumbar surgery.

STUDY DESIGN/SETTING

Retrospective data collection from a single-center prospective cohort study.

PATIENT SAMPLE

A total of 383 prospectively enrolled patients who underwent elective lumbar surgery between 2014 and 2021.

OUTCOME MEASURES

The baseline ODI, 2-year postoperative ODI, and 2-year postoperative patient satisfaction were assessed. Patient satisfaction was evaluated using a scale from 1 (no satisfaction) to 5 (very satisfied). Patients with a score ≥ 4 were defined as satisfied.

METHODS

We prospectively enrolled patients who underwent elective lumbar surgery for degenerative disc disease. Patient reported outcome scores were assessed 2 years postoperatively. The differences between pre- and postoperative ODI were evaluated. Patients with ODI improvement versus no ODI improvement were investigated. Patients were stratified based on whether they achieved patient satisfaction after surgery. A cut-off for ODI improvement, with the goal of achieving patient satisfaction, was calculated using receiver operating characteristic (ROC) analysis. Differences in scores between groups were examined using the Mann-Whitney-U test. Multivariable logistic regression was applied to examine the association between scores and patient satisfaction, adjusted for age, sex and BMI. Statistical significance was set at p<0.05.

RESULTS

A total of 383 patients with age 65 ± 10 years (57% female) were included. Of these, 23% received decompression alone, and 77% underwent fusion and decompression surgery. Baseline ODI significantly improved from 60 ± 21 preoperatively to 18 ± 20 2 years postoperatively in average (p=<0.01). Absolute and percentage ODI changes were 21 ± 12 and 69 ± 35%. An improvement in ODI was achieved in 91% of the patients. In total, 77% of patients showed a satisfaction score of ≥ 4. The baseline (p = 0.02) and postoperative (p < 0.01) assessed ODI, as well as the difference from pre- to postoperative ODI, were significantly associated with patient satisfaction (p < 0.01). Attaining an absolute improvement of ≥ 19 ODI points (AUC 0.75) or ≥ 66% (AUC 0.86) was linked to patient satisfaction. The percentage cut-off value in ODI improvement of 66% was more sensitive and specific than the absolute improvement of 19 points, with a sensitivity of 80% and a specificity of 82%.

CONCLUSIONS

Our results show that improvements in both the baseline and postoperative ODI suggest increased patient satisfaction 2 years following lumbar surgery. A percentage improvement in ODI of ≥ 66% is most indicative for patient satisfaction and is more sensitive and specific than an absolute change in ODI of ≥ 19 points.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.