Patient-Reported and Performance-Based Measures and Patient Satisfaction following Spine Surgery: A Longitudinal Analysis

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

Download Full-text

Key drivers of patient satisfaction with spine surgeons in the outpatient setting

Journal of Neurosurgery Spine ◽

10.3171/2020.9.spine201292 ◽

2021 ◽

pp. 1-8

Author(s):

Nicholas M. Rabah ◽

Hammad A. Khan ◽

Robert D. Winkelman ◽

Jay M. Levin ◽

Thomas E. Mroz ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Spine Surgery ◽

Outpatient Setting ◽

Categorical Variables ◽

Lumbar Spine Surgery ◽

Continuous Variables ◽

Multivariable Logistic Regression Model ◽

Patient Reported ◽

Key Drivers

OBJECTIVE The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS. METHODS All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates. RESULTS The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98–48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96–45.50). CONCLUSIONS The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.

Download Full-text

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2017.12.spine171079 ◽

2018 ◽

Vol 29 (1) ◽

pp. 40-45 ◽

Cited By ~ 8

Author(s):

Aladine A. Elsamadicy ◽

Hanna Kemeny ◽

Owoicho Adogwa ◽

Eric W. Sankey ◽

C. Rory Goodwin ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Racial Disparities ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Readmission Rates ◽

Patient Reported ◽

Short And Long Term ◽

Satisfaction Measures

OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

Download Full-text

The association between patient rating of their spine surgeon and quality of postoperative outcome

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20478 ◽

2020 ◽

pp. 1-7

Author(s):

Nicholas M. Rabah ◽

Hammad A. Khan ◽

Jay M. Levin ◽

Robert D. Winkelman ◽

Thomas E. Mroz ◽

...

Keyword(s):

Mental Health ◽

Patient Satisfaction ◽

Lumbar Spine ◽

Linear Regression ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Linear Regression Analysis ◽

Lumbar Spine Surgery ◽

Patient Rating ◽

Patient Reported

OBJECTIVEThe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes.METHODSAll patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders.RESULTSThe study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year.CONCLUSIONSThe authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients’ satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.

Download Full-text

Impact of preoperative diagnosis on patient satisfaction following lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.11.spine16848 ◽

2017 ◽

Vol 26 (6) ◽

pp. 709-715 ◽

Cited By ~ 17

Author(s):

Charles H. Crawford ◽

Leah Y. Carreon ◽

Mohamad Bydon ◽

Anthony L. Asher ◽

Steven D. Glassman

Keyword(s):

Patient Satisfaction ◽

Outcome Measures ◽

Spine Surgery ◽

Disc Herniation ◽

Preoperative Diagnosis ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Patient Reported

OBJECTIVEPatient satisfaction is a commonly used metric in the current health care environment. While factors that affect patient satisfaction following spine surgery are complex, the authors of this study hypothesized that specific diagnostic groups of patients are more likely to be satisfied after spine surgery and that this is reflected in patient-reported outcome measures. The purpose of this study was to determine if the preoperative diagnosis—disc herniation, stenosis, spondylolisthesis, adjacent segment degeneration, or mechanical disc collapse—would impact patient satisfaction following surgery.METHODSPatients enrolled in the Quality Outcomes Database, formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), completed patient-reported outcome measures, including the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back pain (NRS-BP) and leg pain (NRS-LP) preoperatively and 1-year postoperatively. Patients were stratified by diagnosis and by their response to the satisfaction question: 1) surgery met my expectations; 2) I did not improve as much as I hoped, but I would undergo the same operation for the same results; 3) surgery helped, but I would not undergo the same operation for the same results; or 4) I am the same or worse as compared with before surgery.RESULTSA greater proportion of patients with primary disc herniation or spondylolisthesis reported that surgery met expectations (66% and 67%, respectively), followed by recurrent disc herniation and stenosis (59% and 60%, respectively). A smaller proportion of patients who underwent surgery for adjacent segment degeneration or mechanical disc collapse had their expectations met (48% and 41%, respectively). The percentage of patients that would undergo the same surgery again, by diagnostic group, was as follows: disc herniation 88%, recurrent disc herniation 79%, spondylolisthesis 86%, stenosis 82%, adjacent segment disease 75%, and mechanical collapse 73%. Regardless of diagnosis, mean improvement and ultimate 1-year postoperative ODI, NRS-BP, and NRS-LP reflected patient satisfaction.CONCLUSIONSPreoperative diagnosis was predictive of patient satisfaction following spine surgery. The mean change in and 1-year ODI, NRS-BP, and NRS-LP reflected patient satisfaction regardless of preoperative diagnosis.

Download Full-text

Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

The Spine Journal ◽

10.1016/j.spinee.2017.02.008 ◽

2017 ◽

Vol 17 (7) ◽

pp. 943-952 ◽

Cited By ~ 10

Author(s):

Gregory D. Schroeder ◽

Dom Coric ◽

Han Jo Kim ◽

Todd J. Albert ◽

Kris E. Radcliff

Keyword(s):

Patient Satisfaction ◽

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Patient Reported

Download Full-text

The engaged patient: patient activation can predict satisfaction with surgical treatment of lumbar and cervical spine disorders

Journal of Neurosurgery Spine ◽

10.3171/2019.11.spine191159 ◽

2020 ◽

Vol 32 (6) ◽

pp. 914-920 ◽

Cited By ~ 1

Author(s):

Andrew B. Harris ◽

Floreana Kebaish ◽

Lee H. Riley ◽

Khaled M. Kebaish ◽

Richard L. Skolasky

Keyword(s):

Patient Satisfaction ◽

Surgical Treatment ◽

Spine Surgery ◽

Repeated Measures ◽

Patient Activation ◽

Active Role ◽

Measurement Information ◽

Knowledge And Skills ◽

Patient Reported ◽

Health Domains

OBJECTIVECare satisfaction is an important metric to health systems and payers. Patient activation is a hierarchical construct following 4 stages: 1) having a belief that taking an active role in their care is important, 2) having knowledge and skills to manage their condition, 3) having the confidence to make necessary behavioral changes, and 4) having an ability to maintain those changes in times of stress. The authors hypothesized that patients with a high level of activation, measured using the Patient Activation Measure (PAM), will be more engaged in their care and, therefore, will be more likely to be satisfied with the results of their surgical treatment.METHODSUsing a prospectively collected registry at a multiprovider university practice, the authors examined patients who underwent elective surgery (n = 257) for cervical or lumbar spinal disorders. Patients were assessed before and after surgery (6 weeks and 3, 6, and 12 months) using Patient-Reported Outcomes Measurement Information System (PROMIS) health domains and the PAM. Satisfaction was assessed using the Patient Satisfaction Index. Using repeated-measures logistic regression, the authors compared the likelihood of being satisfied across stages of patient activation after adjusting for baseline characteristics (i.e., age, sex, race, education, income, and marital status).RESULTSWhile a majority of patients endorsed the highest level of activation (56%), 51 (20%) endorsed the lower two stages (neither believing that taking an active role was important nor having the knowledge and skills to manage their condition). Preoperative patient activation was weakly correlated (r ≤ 0.2) with PROMIS health domains. The most activated patients were 3 times more likely to be satisfied with their treatment at 1 year (OR 3.23, 95% CI 1.8–5.8). Similarly, patients in the second-highest stage of activation also demonstrated significantly greater odds of being satisfied (OR 2.8, 95% CI 1.5–5.3).CONCLUSIONSPatients who are more engaged in their healthcare prior to elective spine surgery are significantly more likely to be satisfied with their postoperative outcome. Clinicians may want to implement previously proven techniques to increase patient activation in order to improve patient satisfaction following elective spine surgery.

Download Full-text

Comparison of PROMIS Anxiety and Depression, PHQ-8, and GAD-7 to screen for anxiety and depression among patients presenting for spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2018.9.spine18521 ◽

2019 ◽

Vol 30 (4) ◽

pp. 524-531

Author(s):

Taylor E. Purvis ◽

Brian J. Neuman ◽

Lee H. Riley ◽

Richard L. Skolasky

Keyword(s):

Major Depression ◽

Spine Surgery ◽

Characteristic Curve ◽

Depression Scale ◽

Data Driven ◽

Anxiety And Depression ◽

Measurement Information ◽

Generalized Anxiety ◽

Cut Points ◽

Patient Reported

OBJECTIVEIn this paper, the authors demonstrate to spine surgeons the prevalence and severity of anxiety and depression among patients presenting for surgery and explore the relationships between different legacy and Patient-Reported Outcomes Measurement Information System (PROMIS) screening measures.METHODSA total of 512 adult spine surgery patients at a single institution completed the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), 8-item Patient Health Questionnaire (PHQ-8) depression scale, and PROMIS Anxiety and Depression computer-adaptive tests (CATs) preoperatively. Correlation coefficients were calculated between PROMIS scores and GAD-7 and PHQ-8 scores. Published reference tables were used to determine the presence of anxiety or depression using GAD-7 and PHQ-8. Sensitivity and specificity of published guidance on the PROMIS Anxiety and Depression CATs were compared. Guidance from 3 sources was compared: published GAD-7 and PHQ-8 crosswalk tables, American Psychiatric Association scales, and expert clinical consensus. Receiver operator characteristic curves were used to determine data-driven cut-points for PROMIS Anxiety and Depression. Significance was accepted as p < 0.05.RESULTSIn 512 spine surgery patients, anxiety and depression were prevalent preoperatively (5% with any anxiety, 24% with generalized anxiety screen-positive; and 54% with any depression, 24% with probable major depression). Correlations were moderately strong between PROMIS Anxiety and GAD-7 scores (r = 0.72; p < 0.001) and between PROMIS Depression and PHQ-8 scores (r = 0.74; p < 0.001). The observed correlation of the PROMIS Depression score was greater with the PHQ-8 cognitive/affective score (r = 0.766) than with the somatic score (r = 0.601) (p < 0.001). PROMIS Anxiety and Depression CATs were able to detect the presence of generalized anxiety screen-positive (sensitivity, 86.0%; specificity, 81.6%) and of probable major depression (sensitivity, 82.3%; specificity, 81.4%). Receiver operating characteristic curve analysis demonstrated data-driven cut-points for these groups.CONCLUSIONSPROMIS Anxiety and Depression CATs are reliable tools for identifying generalized anxiety screen-positive spine surgery patients and those with probable major depression.

Download Full-text