Patients’ expectations of spine surgery for degenerative conditions: Results from the Canadian Spine Outcomes and Research Network (CSORN)

Abstract BACKGROUND Understanding patient expectations is a critical component of patient-centered care; however, little is known about which expectation(s) are most important to patients as they relate to their sense of post-operative success. PURPOSE To investigate patient's preoperative expectations of change in symptoms, function and well-being resulting from surgical intervention and to examine the associations between socio-demographic, lifestyle, health status and clinical characteristics with patient outcome expectations. STUDY DESIGN Observational cross-sectional study. SAMPLE Pre-operative data from the Canadian Spine Outcomes and Research Network national registry of patients of patients (n=4333) undergoing surgery for degenerative spinal conditions between 2012 and 2017. OUTCOME MEASURES Patients reported their expectations as a result of the surgery (0 (no change), 1 (somewhat better), 2 (better) or 3 (much better)) for seven items: leg/arm pain, back/ neck pain, independence in everyday activities, sporting activities/recreation, general physical capacity, frequency and quality of social contacts and mental well-being. Patients also reported the single most important change expected. METHODS Data on demographic, lifestyles, health status, clinical factors and reasons for having surgery were also collected. Factor analysis was used to examine the multidimensionality of expectations. Multivariate linear regression was used to examine factors associated with expectations. RESULTS Over 80% of patients reported expectation for improvements (at least somewhat better) in all items with the exception of social contacts (75.8%). Expectations are multidimensional; a two factor structure emerged indicating two expectation dimensions (pain relief and overall functional well-being). Two expectation scores were calculated corresponding to the two dimensions (0-100), with higher scores reflecting higher expectations. The mean ± standard deviation pain relief expectation score was 78.5 ± 24.7 and the mean overall functional well-being expectation score was 69.7 ± 24.4. In multivariate analysis, the variables associated with these dimensions either differed or differed in degree of influence. For example, higher pain and disability scores, thoraco-lumbar location and diagnosis of spondylolisthesiswere associated with higher expectations in both dimensions, while longer disease duration was only associated with lower overall functional well-being expectations. The top three most important expected change items were pain (improvement of leg or arm pain (29.1%) / improvement in back/ neck pain(26.0%)), improvement in general capacity/function (21.0%), and improvement of independence in everyday activities (15.9%). Rankings of the most important expected change were similar across socio-demographic, lifestyle, health status and clinical variables examined. CONCLUSIONS Our findings highlight the need to identify and address specific individual expectations as part of the shared decision-making and pre-surgery education process.