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Sources of Patients’ Expectations of Lumbar Surgery

Mancuso, Carol A., MD∗,†; Duculan, Roland, MD; Cammisa, Frank P., MD; Sama, Andrew A., MD; Hughes, Alexander P., MD; Lebl, Darren R., MD; Girardi, Federico P., MD

doi: 10.1097/BRS.0000000000002830

Study Design. A cross-sectional, mixed methods analysis of sources of expectations of lumbar surgery.

Objective. The aim of this study was to ascertain sources of expectations and compare them to clinical characteristics.

Summary of Background Data. Understanding where patients obtain expectations of lumbar surgery is necessary in order to develop interventions to foster appropriate expectations.

Methods. This was a qualitative-quantitative study of 428 patients interviewed preoperatively with a 20-item validated survey, which asks patients how much improvement they expect per item. Patients then were asked open-ended questions about how they came to have these expectations and, using qualitative analysis, responses were grouped into themes representing different sources of expectations. The likelihood of citing various sources was then assessed with odds ratios (ORs) based on demographic and clinical characteristics.

Results. Patients’ mean age was 55 years, 80% had degenerative diagnoses and 24% had prior lumbar surgery. Patients volunteered multiple sources; most prevalent were current surgeon (83%), internet resources (55%), social network contacts (26%), other physicians (22%); and previous experience (65%) for the subgroup who had prior lumbar surgery. Patients were more likely to cite their surgeon if they had less disability [OR 2.8, confidence interval (CI) 1.3–5.8, P = 0.007], were treated with conservative care, such as physical therapy (OR 2.7, CI 1.6–4.7, P = 0.0003), and had symptoms for ≤12 months (OR 1.8, CI 1.1–3.0, P = 0.03). Patients who cited the internet were employed (OR 2.2; CI 1.5–3.3; P < 0.0001), were treated with physical therapy (OR 1.9; CI 1.2–3.1; P = 0.006), had a negative screen for depression (OR 1.8; CI 1.2–2.8; P = 0.004), and were younger (OR 1.6; CI 1.1–2.4; P = .02). Patients were less likely to expect complete improvement for most items of the survey if they had prior lumbar surgery (P = 0.002) or other orthopedic surgery (P = 0.02).

Conclusion. Patients derive their expectations of lumbar surgery from multiple sources. Some sources are modifiable through enhanced communication with surgeons and potentially through novel modes of education, such as web-based resources that are specifically designed to address expectations.

Level of Evidence: 2

Hospital for Special Surgery, New York, NY

Weill Cornell Medical College, New York, NY.

Address correspondence and reprint requests to Carol A. Mancuso, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021; E-mail:

Received 22 March, 2018

Revised 2 July, 2018

Accepted 18 July, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Agency for Healthcare Research and Quality (R03 HS022913) funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.