Patient Reported Outcomes Predict Patient Satisfaction Up to 5 Years After Cervical Spine Surgery

Patient reported outcomes, including Visual Analog Scale (VAS) and Neck Disability Index (NDI), were significant predictors of patient satisfaction with one- and two-level anterior cervical spine surgery at 2 and 5 years postoperatively, according to findings in the July issue of The Spine Journal.
“After a few years, patient satisfaction is an adequate proxy for the quality of surgery". Photo Source: 123RF.com.The findings are based on a retrospective analysis of prospectively collected data from patients enrolled in the U.S. Food and Drug Administration investigational device exemption randomized clinical trial comparing total disc replacement with Mobi-C^® (Zimmer Biomet) cervical artificial disc (n=389) and anterior cervical discectomy and fusion (ACDF) (n=186). Patients from both surgical groups were combined in this analysis.

The following measures were assessed at 2 and 5 years following surgery: VAS neck pain score, NDI, Short-Form 12-Item scores, and patient satisfaction. As shown in Table 1, the majority of patients were “very satisfied” with the surgery at both time points.

Significant Predictors of Patient Satisfaction

At 2 years, absolute VAS neck score, improvement in NDI score, and absolute NDI score were significantly correlated with patient satisfaction (Table 2). At 5 years, the absolute score and improvement from baseline of both the VAS neck score and the NDI score were correlated with patient satisfaction. In contrast, the SF-12 physical component score was not significantly correlated with patient satisfaction.

Multivariate regression analyses confirmed that improvement in either VAS neck pain score or NDI score was highly significant predictors of patient satisfaction at both 2 years and 5 years.

“These findings help establish that, at least at medium-term follow up, there is a good correlation between patient satisfaction and health-related QOL outcomes,” Dr. Gregory Schroeder told SpineUniverse. Dr. Schroeder is Assistant Professor of Orthopaedic Surgery at Thomas Jefferson University in Philadelphia, PA.

Assessing Satisfaction Immediately After Surgery is Inadequate

Dr. Schroeder said that the current timing for measuring patient satisfaction used by the federal government and insurance companies, which is typically soon after surgery, is “completely inadequate, because previous studies have demonstrated that patient satisfaction is not a good proxy for health-related quality of life outcomes immediately following surgery; however, the current study suggests that satisfaction is a good proxy at 2 and 5 years after surgery.”

“Short-term outcomes can be affected by things such as wait time, a poor interaction with the ancillary staff, the parking situation, or even a minor complication,” Dr. Schroeder said. “However, a few years after surgery, patients are primarily going to be satisfied with outcomes if their symptoms have resolved.”

“This study demonstrates that if insurance companies and the federal government want to evaluate patient satisfaction, they really should wait to see how the surgery has improved the patient’s quality of life a few years after surgery,” Dr. Schroeder said. “After a few years, patient satisfaction is an adequate proxy for the quality of surgery, but it may not be accurate immediately after surgery.”

Implications for Patient Counseling

“These findings allow us to tell patients that even if there are some minor setbacks in the immediate postoperative period, as long as their neurologic symptoms are improved, they will likely be satisfied down in the future,” Dr. Schroeder said.