Tuesday, July 24, 2012

Comparison Between Patient and Surgeon Perception of Outcomes of Operations for Degenerative Spi

INTRODUCTION: Patient-filled questionnaires, such as Oswestry Disability Index (ODI) or Neck Disability Index (NDI) have become the mainstay in the evaluation of treatment outcomes in degenerative spine disease (DSD), replacing result-reporting by surgeons. In this study we set to compare patients' and surgeons' assessment of spine treatment outcome in a prospective blinded patient-driven spine surgery outcomes registry. METHODS: Patients referred to the neurosurgery clinic between 9/8/09 and 11/1/2011 filled out surveys at baseline, at recruitment preoperatively, and at 3- and 6- months postoperatively. The surgeons were blinded to the survey content. Pain was rated on a Visual Analog Scale (VAS) from 0 to 10, while NDI was scored for cervical spine patients and ODI for lumbar patients. At 3- and 6- months postoperatively, outcome was rated independently by patients and surgeons on a 7-point Likert-type scale RESULTS: 337 patients prospectively enrolled in the database with intention to treat; 134 (40%) had cervical spine disease, 195 (58%) had lumbar spine disease and 8 patients (2%) had both. 109 (32%) had outcome ratings from both the patient and the surgeon in corresponding time frames. We found that surgeons' and patients' ratings correlated strongly (Spearman rho = 0.4, ***P < 0.0001); with 44.6% identical and 86.7% within +/- 1 grade of each other. Patient rating correlated better with most recent NDI/ODI and pain score than with the incremental change from the baseline. In a multivariate analysis, the age of the patient and identity of the surgeon were the only variables that had significant impact on the ratings' discrepancy (*P = 0.02 and *P = 0.04, respectively). CONCLUSION: We show that patients' and surgeons' global outcome ratings for spinal disease correlate highly with each other. Also, patients' ratings correlate better with their most recent functional scores rather than the incremental change from their baseline. Copyright (C) by the Congress of Neurological Surgeons





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