title: Patient-oriented outcomes from low back surgery: a community-based study.
abstract: METHODS
  This study used a prospective cohort design.
  
  
  OBJECTIVE
  To examine factors associated with favorable self-reported patient outcomes 1 year after elective surgery for degenerative back problems.
  
  
  BACKGROUND
  Many previous studies addressing the results of low back surgery have been conducted in academic institutions or by single surgeons. As part of a quality improvement effort, surgeons in private practice led a community-based outcomes management project in Washington State.
  
  
  METHODS
  Patients ages 18 and older with the following diagnoses were eligible for the study: degenerative changes, herniated disc, instability, and spinal stenosis. Nine orthopedists and neurosurgeons enrolled a total of 281 patients. Participants were asked to complete baseline and 1-year follow-up surveys. Data concerning diagnoses, clinical signs, and operative procedures were provided by the surgeons. The researchers examined sociodemographic characteristics, self-reported symptoms before surgery, preoperative clinical signs, diagnoses, and operative procedures associated with three primary outcomes: better functioning, improved quality of life, and overall treatment satisfaction.
  
  
  RESULTS
  Follow-up surveys were completed by 236 (84%) of the enrolled patients. Approximately two thirds of the study participants reported much better functioning (65%), a great quality of life improvement (64%), and a very positive perspective about their treatment outcome (68%). The following variables were associated with worse patient outcomes: older age, previous low back surgery, workers' compensation coverage, and consultation with an attorney before surgery. Patients undergoing a fusion procedure were more likely to report good outcomes.
  
  
  CONCLUSIONS
  The authors' experience indicates that community-based outcomes data collection efforts are feasible and can be incorporated into usual clinical practice. The study results indicate that compensation payments and litigation are two important predictors of poor outcomes after low back surgery in community practice. Because of small numbers, varied diagnoses, and possible selection bias, the findings with respect to fusion should be interpreted cautiously.
authors.affiliation: Department of Health Services, the Department of Medicine, the Center for Cost and Outcomes Research, University of Washington, Seattle, Washington, USA. vtaylor@fhcrc.org
authors.forename: V M
authors.initials: VM
authors.lastname: Taylor
authors.forename: R A
authors.initials: RA
authors.lastname: Deyo
authors.forename: M
authors.initials: M
authors.lastname: Ciol
authors.forename: E L
authors.initials: EL
authors.lastname: Farrar
authors.forename: M S
authors.initials: MS
authors.lastname: Lawrence
authors.forename: N H
authors.initials: NH
authors.lastname: Shonnard
authors.forename: K M
authors.initials: KM
authors.lastname: Leek
authors.forename: B
authors.initials: B
authors.lastname: McNeney
authors.forename: H I
authors.initials: HI
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards; D017060:Patient Satisfaction; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014861:Washington