Effect of patients' functional status on satisfaction with outcomes 12 months after elective spine surgery for lumbar degenerative disease

Silky Chotai; Clinton J Devin; Kristin R Archer; Mohamad Bydon; Matthew J McGirt; Hui Nian; Frank E Harrell Jr; Robert S Dittus; Anthony L Asher; QOD Vanguard Sites

doi:10.1016/j.spinee.2017.05.027

Effect of patients' functional status on satisfaction with outcomes 12 months after elective spine surgery for lumbar degenerative disease

Spine J. 2017 Dec;17(12):1783-1793. doi: 10.1016/j.spinee.2017.05.027. Epub 2017 Sep 29.

Authors

Silky Chotai¹, Clinton J Devin¹, Kristin R Archer², Mohamad Bydon³, Matthew J McGirt⁴, Hui Nian⁵, Frank E Harrell Jr⁵, Robert S Dittus⁶, Anthony L Asher⁷; QOD Vanguard Sites

Collaborators

QOD Vanguard Sites:
Anthony L Asher⁴, Matthew J McGirt⁴, Clinton J Devin⁸, Kevin T Foley⁹, Jeffrey M Sorenson⁹, John J Knightly¹⁰, Steven D Glassman¹⁰, Thomas B Briggs¹¹, Adam Kremer¹², Wesley E Griffitt¹³, Noam Y Stadlan¹⁴, Thomas W Grahm¹⁵, Meic H Schmidt¹⁶, Praveen Mummaneni¹⁷, Mark E Shaffrey¹⁸

Affiliations

¹ Department of Orthopaedic and Neurological Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA.
² Department Orthopaedic Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
⁴ Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, NC, USA.
⁵ Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
⁶ Departments of Medicine, Division of General Internal Medicine and Public Health, Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, TN, USA; VA Tennessee Valley Geriatric Research, Education and Clinical Center, Vanderbilt University School of Medicine, Nashville, TN, USA.
⁷ Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, NC, USA. Electronic address: asher@cnsa.com.
⁸ Department of Orthopedics Surgery and Neurosurgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, USA.
¹⁰ Department of Neurosurgery, Atlantic Neurosurgical Specialists, Morristown, NJ, USA.
¹¹ Springfield Neurologic and Spine Institute, Springfield, MO, USA.
¹² Department of Neurosurgery, Brain and Spine Center, Holland, MI, USA.
¹³ Department of Neurosurgery, Bay Care Clinic Neurological, Green Bay, WI, USA.
¹⁴ Department of Neurosurgery, North Shore University Health System, Skokie, IL, USA.
¹⁵ Department of Surgery, Tyler Neurosurgical, East Texas Medical Center, Tyler, TX, USA.
¹⁶ Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
¹⁷ Department of Neurological Surgery, University of California, San Francisco, USA.
¹⁸ Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.

PMID: 28970074
DOI: 10.1016/j.spinee.2017.05.027

Abstract

Background: Comprehensive assessment of quality of care includes patient-reported outcomes, safety of care delivered, and patient satisfaction. The impact of the patient-reported Oswestry Disability Index (ODI) scores at baseline and 12 months on satisfaction with outcomes following spine surgery is not well documented.

Purpose: This study aimed to determine the impact of patient disability (ODI) scores at baseline and 12 months on satisfaction with outcomes following surgery.

Study design: Analysis of prospectively collected longitudinal web-based multicenter data.

Patient sample: Patients undergoing elective surgery for degenerative lumbar disease were entered into a prospective multicenter registry.

Outcome measures: Primary outcome measures were ODI, North American Spine Society satisfaction (NASS) questionnaire.

Methods: Baseline and 12-month ODI scores were recorded. Satisfaction at 12 months after surgery was measured using NASS questionnaire. Multivariable proportional odds logistic regression analysis was conducted to determine the impact of baseline and 12-month ODI on satisfaction with outcomes.

Results: Of the total 5,443 patients, 64% (n=3,460) were satisfied at a level where surgery met their expectations (NASS level 1) at 12 months after surgery. After adjusting for all baseline and surgery-specific variables, the 12-month ODI score had the highest impact (Wald χ²=1,555, 86% of the total χ²) on achieving satisfaction with outcomes compared with baseline ODI scores (Wald χ²=93, 5% of the total χ²). The level of satisfaction decreases with increasing 12-month ODI score. Greater change in ODI is required to achieve a better satisfaction level when the patient starts with a higher baseline ODI score.

Conclusion: Absolute 12-month ODI following surgery had a significant association on satisfaction with outcomes 12 months after surgery. Patients with higher baseline ODI required a larger change in ODI score to achieve satisfaction. No single measure can be used as a sole yardstick to measure quality of care after spine surgery. Satisfaction may be used in conjunction with baseline and 12-month ODI scores to provide an assessment of the quality of spine surgery provided in a patient centric fashion.

Keywords: Degenerative; ODI; Outcomes; PROs; Patient-reported outcomes; QOD; Quality; Satisfaction; Spine; Surgery.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Elective Surgical Procedures / adverse effects
Elective Surgical Procedures / psychology*
Female
Humans
Intervertebral Disc Degeneration / surgery*
Lumbar Vertebrae / surgery
Male
Middle Aged
Patient Satisfaction*
Prospective Studies
Registries
Surveys and Questionnaires