Abstract and Introduction
Abstract
Study Design. Cross-sectional analysis of patients’ expectations of cervical spine surgery using the Hospital for Special Surgery Cervical Spine Surgery Expectations Survey (Expectations Survey).
Objective. To preoperatively describe patients’ long-term expectations of surgery in terms of demographic, clinical, and psychological characteristics.
Summary of Background Data. Although important components of patient-centered care, few studies have systematically considered patients’ expectations of cervical spine surgery.
Methods. Several days before surgery, 150 patients completed the Expectations Survey, which is composed of 20 physical and psychological items; scores range from 0 to 100, and higher scores reflect choosing more items and more improvement (i.e., more expectations). Patients completed additional questionnaires addressing demographic, psychological, and clinical status, including disability due to pain with the Neck Disability Index (NDI) and overall physical and mental health with the 12-item Short Form Health Survey.
Results. Mean age was 54 years, and 61% were males. The most commonly chosen items were relieve neck (87%) and upper extremity (85%) pain, stop the spine condition from getting worse (97%), and remove the control the spine condition had on life (96%). Twenty-three percent of patients chose all 20 items, 39% chose 16 to 19 items, and 38% chose 15 or fewer items. In multivariate analysis, patients were more likely to choose more items if they were younger (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.2–4.0; P = 0.01), had worse NDI scores (OR = 6.5; 95% CI, 3.2–13.2; P < 0.0001), and had worse SF-12 Physical (OR = 1.9; 95% CI, 1.0–3.6; P = 0.05) and Mental Health scores (OR = 2.0; 95% CI, 1.1–3.6; P = 0.02). The Expectations Survey scores ranged from 10 to 100, and the mean score was 65 ± 24. In multivariate analysis, patients were more likely to have higher scores if they were younger (OR = 2.8; 95% CI, 1.4–6.0; P = 0.006) and had worse NDI scores (OR = 6.0; 95% CI, 2.8–13.2; P < 0.0001).
Conclusion. Multiple clinical variables were associated with expectations, with younger age and more disability due to pain being the most consistently associated with more expectations.
Level of Evidence: 3
Introduction
Understanding patients’ expectations of long-term outcome is an important component of patient-centered orthopedic care.[1,2] This is particularly true for elective procedures wherein patients’ perspectives often are the catalyst for surgery. Knowing what patients expect helps the surgeon direct patient education, foster shared decision making, and set mutual goals with patients.[3] Assessing expectations can be complex, however, especially in patients undergoing cervical spine surgery, wherein consideration and anticipation of one’s future condition may substantively affect treatment decisions today.[4]
Few studies have formally assessed patients’ expectations of cervical spine surgery. Those that have queried patients about a few items and had different response options, making it difficult to draw conclusions across studies.[4–6] In addition, questions were developed on the basis of expert opinion and thus may encompass only the most likely and reasonable expectations. Although this approach certainly addresses salient expectations, it may not capture the full spectrum of patients’ physical and psychological expectations, some of which may be unrealistic.
We previously developed and tested the Hospital for Special Surgery Cervical Spine Surgery Expectations Survey (hereafter referred to as the Expectations Survey).[7] The Expectations Survey is a questionnaire that was developed on the basis of a mixed qualitative-quantitative approach, with all items in the Expectations Survey derived from patients’ input. The objectives of this current report are, first, to use the Expectations Survey to calculate the prevalence of patients’ long-term expectations of surgery and, second, to assess these in terms of demographic, clinical, and psychological characteristics.
