title: Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.
abstract: OBJECTIVE
  Patients frequently have misconceptions regarding diagnosis, surgical indication, and expected outcome following spinal surgery for degenerative spinal disease. In this study, we sought to understand the relationship between patient-perceived surgical indications and patient expectations. We hypothesized that patients reporting appendicular symptoms as a primary surgical indication would report a higher rate of having expectations met by surgery compared to those patients reporting axial symptoms as a primary indication.
  
  
  METHODS
  Questionnaires were administered to patients who had undergone surgery for degenerative spinal disease at 2 tertiary care institutions. Questions assessed perception of the primary indication for undergoing surgery (radicular versus axial), whether the primary symptom improved after surgery, and whether patient expectations were met with surgery. Outcomes of interest included patient-reported symptomatic improvement following surgery and expectations met by surgery. Various factors were assessed for their relationship to these outcomes of interest.
  
  
  RESULTS
  There were 151 unique survey respondents. Respondents were nearly split between having a patient-perceived indication for surgery as appendicular symptoms (55.6%) and axial symptoms (44.4%). Patient-perceived surgical indication being appendicular symptoms was the only factor predictive of patient-reported symptomatic improvement in our logistic regression model (OR 2.614; 95% CI 1.218-5.611). Patient-perceived surgical indication being appendicular symptoms (OR 3.300; 95% CI 1.575-6.944) and patient-reported symptomatic improvement (OR 33.297; 95% CI 12.186-90.979) were predictive of patients reporting their expectations met with surgery in both univariate and multivariate logistic regression modeling.
  
  
  CONCLUSIONS
  We found that patient-reported appendicular symptoms as the primary indication for surgery were associated with a higher rate of both subjective improvement following surgery and having expectations met by surgery. Studies such as ours point to the fact that while performing technically superlative operations is paramount, it may be equally important to address other factors that help determine patient perception of the surgery experience.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Franz
authors.affiliation: The Spine Center, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA.
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Vollmer
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kate W-C
authors.initials: KW
authors.lastname: Chang
authors.affiliation: Saint Luke's Marion Bloch Neuroscience Institute, Division of Neurosurgery, Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Cheerag
authors.initials: C
authors.lastname: Upadhyaya
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: ljsyang@med.umich.edu.
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011336:Probability; D013122:Spinal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires
keywords: Degenerative spine disease; Patient expectations; Patient satisfaction; Surgical outcome