Concordance Between Patients’ and Surgeons’ Expectations of Lumbar Surgery

Abstract

Study Design. 

Longitudinal cohort.

Objective. 

Measure concordance between patients’ and surgeons’ preoperative expectations of lumbar surgery; determine which member of the dyad more closely predicted fulfillment of expectations, defined as patient-reported status postoperatively.

Summary of Background Data. 

Concordant patient-surgeon expectations reflect effective communication and should foster better outcomes.

Methods. 

Preoperatively patients and surgeons completed identical surveys measuring expectations for improvement in symptoms and physical/psychosocial function. Responses ranged from “complete improvement” to “do not have this expectation”; scores for each survey ranged from 0–100 (greatest expectations). Concordance between pairs of patient-surgeon scores was measured with the intraclass correlation coefficient (ICC). Postoperatively fulfillment of expectations was measured from patient-reported amount of improvement received and was calculated as the proportion of patient-reported postoperative score relative to 1) patient-reported preoperative score, and 2) surgeon-reported preoperative score; (range 0 (no expectations fulfilled) to >1 (expectations surpassed)). Clinical measures included patient-reported spine-related disability.

Results. 

For 402 patient-surgeon pairs, mean survey scores were 73 ± 19 (patients) and 57 ± 16 (surgeons); 84% of patients had higher scores than surgeons, mainly due to expecting complete improvement while surgeons expected a lot/moderate/little improvement. The ICC for the entire sample was .31 (fair agreement); for sub-groups the greatest difference in ICC was for patients with more spine-related disability (ICC = .10, 95%CI .00-.23) versus less disability (ICC = .46, 95%CI .34-.56). 96% of patients were contacted ≥2.0 years postoperatively. Proportions of expectations fulfilled were .79 (0–3.00) (patients) and 1.01 (0–2.29) (surgeons). Thus patients were less likely to anticipate subsequent postoperative status (OR 0.34, 95%CI 0.25–0.45) versus surgeons who were more likely to anticipate patient-reported postoperative status (OR 2.98, 95% CI 2.22–4.00).

Conclusions. 

Concordance between patients’ and surgeons’ expectations was fair; due mostly to patients expecting complete improvement while surgeons expected a lot/moderate/little improvement. Compared to patients’ expectations, surgeons’ expectations more closely coincided with patient-reported fulfillment of expectations 2 years postoperatively.

Level of Evidence: 1