title: The bothersomeness of patient self-rated "complications" reported 1 year after spine surgery.
abstract: OBJECTIVE
  The last few decades have witnessed a paradigm shift in the assessment of outcome in spine surgery, with patient-centred questionnaires superseding traditional surgeon-based assessments. The assessment of complications after surgery and their impact on the patient has not enjoyed this same enlightened approach. This study sought to quantify the incidence and bothersomeness of patient-rated complications 1 year after surgery.
  
  
  METHODS
  Patients with lumbar degenerative disorders, operated with the goal of pain relief between October 2006 and September 2010, completed a questionnaire 1 year postoperatively enquiring about complications arising as a consequence of their operation. They rated the bothersomeness of any such complications on a 5-point scale. Global outcome of surgery and satisfaction at the 12-month follow-up were also rated on 5-point Likert scales. The multidimensional Core Outcome Measures Index (COMI) was completed preoperatively and at the 12-month follow-up.
  
  
  RESULTS
  Of 2,282 patients completing the questionnaire (92% completion rate), 687 (30.1%) reported complications, most commonly sensory disturbances (36% of those with complications) or ongoing/new pain (26%), followed by motor problems (8%), pain plus neurological disturbances (11%), and problems with wound healing (6%). The corresponding "bothersomeness" ratings for these were: 1% not at all, 23% slightly, 27% moderately, 31% very, and 18% extremely bothersome. The greater the bothersomeness, the worse the global outcome (Rho = 0.51, p < 0.0001), patient satisfaction (Rho = 0.44, p < 0.0001) and change in COMI score (Rho = 0.52, p < 0.0001).
  
  
  CONCLUSIONS
  Most complications reported by the patient are perceived to be at least moderately bothersome and hence are not inconsequential. Complications and their severity should be assessed from both the patient's and the surgeon's perspectives--not least to better understand the reasons for poor outcome and dissatisfaction with treatment.
authors.affiliation: Spine Center Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland. anne.mannion@kws.ch
authors.forename: A F
authors.initials: AF
authors.lastname: Mannion
authors.forename: U M
authors.initials: UM
authors.lastname: Mutter
authors.forename: F T
authors.initials: FT
authors.lastname: Fekete
authors.forename: D
authors.initials: D
authors.lastname: O'Riordan
authors.forename: D
authors.initials: D
authors.lastname: Jeszenszky
authors.forename: F S
authors.initials: FS
authors.lastname: Kleinstueck
authors.forename: F
authors.initials: F
authors.lastname: Lattig
authors.forename: D
authors.initials: D
authors.lastname: Grob
authors.forename: F
authors.initials: F
authors.lastname: Porchet
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis*; D011788:Quality of Life; D057566:Self Report; D012678:Sensation Disorders / Q000209:etiology; D013131:Spine / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome