Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: A multicenter study

STUDY DESIGN.: Analysis of prospectively collected multicenter data. OBJECTIVE.: To explore the relationship between preoperative expectations and postoperative outcomes and satisfaction in lumbar and cervical spine surgery. SUMMARY OF BACKGROUND DATA.: Back pain is one of the most common health problems, leading to the utilization of health care resources, work loss, and sick benefits. Patient expectations influence posttreatment outcomes, both surgical and nonsurgical. There is little research on the importance of preoperative expectations in spine surgery. Existing studies evaluate the technical aspects of interventions and functional outcomes but fail to take into account patient expectations. The authors hypothesized that expectations dramatically affect spine patient satisfaction independent of functional outcomes. METHODS.: Prospectively collected patient-entered data from patients undergoing lumbar and cervical spine surgery from 2 study centers collected using a Web-based patient health survey system were analyzed. The study included patients who underwent operative intervention (decompression with or without fusion) with at least a 3-month period of follow-up. Preoperative expectations were measured using the Musculoskeletal Outcomes Data Evaluation and Management System's (MODEMS) expectation survey. Postoperative satisfaction and fulfillment of expectations were measured using the MODEMS satisfaction survey. Postoperative functional outcomes were measured using the Oswestry Disability Index and 36-item short form health survey. Ordinal logistic regression multivariate modeling was used to examine predictors of postoperative satisfaction. Linear regression multivariate modeling was used to examine predictors of functional outcomes. RESULTS.: Greater fulfillment of expectations led to higher postoperative satisfaction and was associated with better functional outcomes. Higher preoperative expectations led to decreased postsurgical satisfaction but were associated with improved functional outcomes. Higher postoperative satisfaction was associated with improved functional outcomes and vice versa. Type of surgery also influenced satisfaction and function, with cervical patients being less satisfied but having better functional outcomes than lumbar patients. CONCLUSION.: This study showed that more than functional outcomes matter; preoperative expectations and fulfillment of expectations influence postoperative satisfaction in patients undergoing lumbar and cervical spine surgery. This underlines the importance of taking preoperative expectations into account to obtain an informed choice on the basis of the patient's preferences.