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Patient Expectations for Lumbar Surgery Often Too High

Surgeons more accurate at predicting two-year follow-up outcomes

TUESDAY, Dec. 1, 2020 (HealthDay News) — Surgeons are more accurate than patients in predicting two-year patient-reported outcomes following lumbar surgery, according to a study published online Nov. 4 in Spine.

Carol A. Mancuso, M.D., from the Hospital for Special Surgery in New York City, and colleagues assessed concordance between patients’ and surgeons’ preoperative expectations of lumbar surgery and evaluated whose expectations more closely predicted fulfillment of expectations. Patients and surgeons each completed preoperative surveys (402 patient-surgeon pairs).

The researchers found that 84 percent of patients had higher expectation scores than surgeons, mainly due to expecting complete improvement, while surgeons expected a lot/moderate/little improvement. For the entire sample, there was fair agreement. The greatest differences in agreement were seen for patients with more spine-related disability (intraclass correlation coefficient [ICC], 0.10; 95 percent confidence interval [CI], 0.00 to 0.23) versus less disability (ICC, 0.46; 95 percent CI, 0.34 to 0.56). Ninety-six percent of patients were contacted two or more years postoperatively. The mean proportion of expectations fulfilled was 0.79 and 1.01 for patients and surgeons, respectively. Patients were less likely to anticipate subsequent postoperative status (odds ratio [OR], 0.34; 95 percent CI, 0.25 to 0.45) versus surgeons (OR, 2.98; 95 percent CI, 2.22 to 4.00).

“Our study underscores that there is room for improvement in patient education and that patients should rely on their surgeon’s expertise when forming expectations of lumbar spine surgery,” a coauthor said in a statement.

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