A comparison of patient and surgeon preoperative expectations of spinal surgery.

STUDY
DESIGN: Cross-sectional study of agreement between patients' and surgeons' expectations of the outcome of spinal surgery.
OBJECTIVE: Patients' satisfaction after spinal surgery depends, in part, on whether their expectations of surgery are fulfilled. Whether the patient always fully understands the key messages conveyed by the surgeon, to formulate realistic expectations, is not known. This study evaluates the level of agreement in expectations declared preoperatively by the patient and the surgeon. SUMMARY OF BACKGROUND DATA: Previous studies have investigated the importance of realistic expectations for the patients' satisfaction with surgical treatments, but there is still a need for a more detailed analysis in the field of spinal surgery.
METHODS: The study included 225 German-speaking patients (92 men and 133 women; mean ± SD [range] age, 62 ± 15 [15-90] yr) and their treating spinal surgeons (N = 7). Following the preoperative informed consent consultation, the patient and the surgeon independently completed a questionnaire about baseline neurological status and realistic expectations regarding various patient-orientated outcomes (axial pain (back/neck), radiating pain (leg/arm), pain medication usage, sensory and motor function, and the ability to work, do household activities, and play sports). Concordance was given by percent agreement and κ coefficients.
RESULTS: Agreement between the patient and the surgeon about the existence of spine-related neurological deficits occurred in 75% (sensory) and 61% (motor) cases. The patient but not the surgeon reported a sensory deficit in 20% cases and motor deficit in 35% cases; for 4% to 5% cases, the physician reported such a deficit that the patient was seemingly unaware of. The patients consistently had higher expectations than the surgeons, especially for back or neck pain and function (work, household activities, and sports); weighted κ values for agreement were low, ranging from 0.097 to 0.222.
CONCLUSION: The findings demonstrate wide discrepancies between the patient and the surgeon regarding the expected result of surgery. They highlight the need for clearer explanations of the association between the spinal problem and neurological deficits and the improvement that can be expected in pain and function after surgery. Systematic, routine evaluation of outcomes should assist in deriving the information necessary to document the improvement achieved and to formulate realistic expectations of surgery.