title: Proportion of Expectations Fulfilled: A New Method to Report Patient-centered Outcomes of Spine Surgery.
abstract: METHODS
  Prospective lumbar and cervical surgery cohorts.
  
  
  OBJECTIVE
  Compare fulfillment of expectations with traditional global outcomes and provide evidence for its validity.
  
  
  BACKGROUND
  New lumbar and cervical spine surgery Expectations Surveys can be used to measure fulfillment of expectations and their performance should be compared with existing outcomes.
  
  
  METHODS
  Three hundred thirty-six lumbar and 133 cervical spine surgery patients preoperatively completed valid 20-item Expectations Surveys measuring symptoms, function, and psychological well-being. Approximately 2 years postoperatively patients rated how much improvement they received for each item. The proportion of expectations fulfilled was compared with traditional outcomes, including global satisfaction and change in standard spine questionnaires, with correlation coefficients (r) and areas under receiver operator characteristic curves (AUC).
  
  
  RESULTS
  Ninety percent of lumbar patients had some expectations fulfilled (24% had all expectations fulfilled completely or exceeded). The mean proportion of expectations fulfilled was 0.66 and was associated with satisfaction (r = 0.73 (95% CI 0.68-0.78); AUC = 0.92 (95% CI 0.89-0.95) (P < 0.0001)). Based on the association with satisfaction, a clinically important proportion of expectations fulfilled for lumbar surgery is approximately 0.60 (sensitivity 0.90, specificity 0.79).Ninety-one percent of cervical patients had some expectations fulfilled (31% had all expectations fulfilled completely or exceeded). The mean proportion of expectations fulfilled was 0.78 and was associated with satisfaction (r = 0.62 (95% CI 0.50-0.72); AUC = 0.92 (95% CI 0.87-0.97) (P < 0.0001)). Based on the association with satisfaction, a clinically important proportion of expectations fulfilled for cervical surgery is approximately 0.62 (sensitivity 0.91, specificity 0.80).
  
  
  CONCLUSIONS
  The proportion of expectations fulfilled is a new patient-centered outcome that measures results of spine surgery. Unique features of this novel outcome are that it requires prospectively acquired pre- and postoperative data, provides details about in what ways patients believe surgery did and did not meet goals, and offers surgeons opportunities to address unfilled expectations directly.
  
  
  METHODS
  1.
authors.affiliation: Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Roland
authors.initials: R
authors.lastname: Duculan
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Hughes
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Lebl
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000639:trends; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods* / Q000639:trends; D011446:Prospective Studies; D058028:Research Report; D016896:Treatment Outcome