Comparison of patient and surgeon ratings of outcome 12 months after spine surgery: presented at the 2009 Joint Spine Section Meeting.
OBJECTIVE
The contemporary assessment of spine surgical outcome primarily relies on patient-centered reports of symptoms and function. Such measures are considered to reduce bias compared with traditional surgeon-based outcome ratings. This study examined the agreement between patients' and surgeons' ratings of outcome 1 year after spine surgery.


METHODS
The study involved 404 patients (mean age 56.6 +/- 16.4 years; 259 women, 145 men) and their treating surgeons. At baseline and 12 months postoperatively patients completed the Core Outcome Measures Index (COMI) rating pain, function, quality of life, and disability. At 12 months postoperatively, they also rated the global outcome of surgery and their satisfaction with treatment. The surgeon, blinded to the patient's evaluation, rated the global outcome of surgery as excellent, good, fair, or poor.


RESULTS
Seventy-six percent of the patients who were considered by the surgeon to have an excellent or good outcome achieved the minimum clinically important difference (MCID) of a 2.2-point reduction on the COMI; 24% achieved less than the MCID. There was a significant correlation between the surgeons' and patients' global outcome ratings (Spearman rho = 0.56; p < 0.0001). The degree of absolute agreement between them was significantly influenced by surgeon seniority: senior surgeons "overrated" the outcome in 24.5% of cases (compared with patients' ratings) and "underrated" it in 17.5% of cases. Junior surgeons overrated in 7.8% of cases and underrated in 43.8% of cases (p < 0.0001). Surgeon overrating occurred significantly more frequently for patients with a poor self-rated outcome (measured as global outcome, COMI score, or satisfaction with treatment). In a multivariate model, the independent variables "senior surgeon" and "patient dissatisfaction with care" were the most significant unique predictors of surgeon overrating of the global outcome (p < 0.0001; adjusted R(2) for the model = 0.16).


CONCLUSIONS
Overall, agreement between surgeon and patient was reasonably good. The majority of patients who were rated as excellent/good by the surgeons had achieved the MCID in the prospectively measured COMI score. Discrepancies in outcome ratings were influenced by surgeon seniority and patient satisfaction. For a balanced view of the surgical result, outcomes should be assessed from the perspectives of both the patient and the surgeon.
Porchet
François
F
Department of Neurosurgery, Spine Center, Schulthess Klinik, Zürich, Switzerland.
Lattig
Friederike
F
Grob
Dieter
D
Kleinstueck
Frank S
FS
Jeszenszky
Dezsö
D
Paus
Christophe
C
O'Riordan
David
D
Mannion
Anne F
AF
D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013131:Spine / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome