Patient expectations, outcomes and satisfaction: related, relevant or redundant?

Study design:  A prospective case series of patients undergoing lumbar spine surgery.

Objective:  Is there a correlation between patients' expectations before lumbar surgery, postoperative outcomes, and satisfaction levels?

Methods:  A prospective study of 145 patients undergoing primary, single-level surgery for degenerative lumbar conditions was conducted. Oswestry Disability Index, back Visual Analog Scale (VAS), and leg VAS were assessed preoperatively and at 6 weeks and 6 months after surgery. Patients' expectations were measured preoperatively by asking them to score the level of pain and disability that would be least acceptable for them to undergo surgery and be satisfied. Satisfaction was assessed 6 weeks postoperatively with a Likert scale. Differences in patient expectations between actual and expected improvements were quantified.

Results:  Most patients had a clinically relevant improvement, but only about half achieved their expectations. Satisfaction did not correlate with preoperative pain or disability, or with patient expectation of improvement. Instead, satisfaction correlated with positive outcomes.

Conclusions:  Patient expectations have little bearing on final outcome and satisfaction. [Table: see text].