title: Patient-Specific Factors Associated With Dissatisfaction After Elective Surgery for Degenerative Spine Diseases.
abstract: BACKGROUND
  Patient satisfaction metrics are emerging as determinants of quality of care and reimbursement after spine surgery. Identifying modifiable factors that improve satisfaction is of utmost importance.
  
  
  OBJECTIVE
  To evaluate whether patient-related factors or patient-reported outcomes could predict dissatisfaction after spine surgery.
  
  
  METHODS
  Patients undergoing elective surgery for degenerative lumbar and cervical disease over a period of 2 years were enrolled in a prospective longitudinal registry. Patient-reported outcome, the Oswestry Disability Index (ODI)/Neck Disability Index (NDI), and numeric rating scale for back/neck (BP/NP) and leg/arm pain (LP/AP), were recorded at baseline and the 12-month follow-up. Previously published values of minimal clinically important differences of 14.9% for ODI, 17.3% for NDI, 2.1/2.6 for BP/NP, and 2.8/4.1 for LP/AP were used. Patient satisfaction was assessed with the North American Spine Society Satisfaction Questionnaire.
  
  
  RESULTS
  A total of 1645 patients underwent elective spine surgery (811 male patients; age, 57 ± 13 years). Eighty-three percent of patients (1362) reported satisfaction with outcome 12 months after surgery. In a multivariable analysis, after controlling for an array of patient-specific factors, the inability to achieve minimal clinically important difference for ODI/NDI (P < .001; odds ratio [OR] = 4.215; 95% confidence interval [CI], 2.7-6.5), BP/NP pain (P < .001; OR = 3.1; 95% CI, 2.188-4.43), and LP/NP (P < .001; OR = 2.6, 95% CI, 1.8-3.6); Medicaid/uninsured payer status (P = .04; OR = 1.39; 95% CI, 1.01-1.93); and higher baseline ODI/NDI (P = .002; OR = 1.11; 95% CI, 1.04-1.19) and BP/NP scores (P = .002; OR = 1.03; 95% CI, 1.01-1.06) were the independent predictors of patient dissatisfaction at 12 months after surgery.
  
  
  CONCLUSIONS
  Patient satisfaction with outcome may accurately represent the effectiveness of surgical spine care in terms of 1-year improvement in pain and disability. However, healthcare stakeholders relying on satisfaction as a proxy of overall quality or effectiveness of care need to account for Medicaid/uninsured payer status and worse baseline pain and disability scores as confounders.
authors.affiliation: *Department of Orthopedics Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ‡Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
authors.forename: Silky
authors.initials: S
authors.lastname: Chotai
authors.forename: Ahilan
authors.initials: A
authors.lastname: Sivaganesan
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D004185:Disability Evaluation; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D012959:Socioeconomic Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States