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  • Comparison Between Patient and Surgeon Perception of Outcomes of Operations for Degenerative Spine Disease: A Prospective Blinded Database Study

    Final Number:

    Ben Z. Roitberg MD; Bart Thaci MD; Frederick D. Brown MD; Jingjing Shen MD; Sandi Karen Lam MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Patient filled questionnaires, such as Oswestry Disability Index (ODI) or Neck Disability Index (NDI) have become the mainstay in 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 0-10, 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).

    Conclusions: 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.

    Patient Care: Patients' and surgeons' ratings of outcome correlate highly and should be used together in determination of surgical results.

    Learning Objectives: (1) Understand how patients’ and surgeons’ outcome ratings of DSD compare to each other; (2) How patients perception of outcome correlates with commonly used functional score such as NDI/ODI/VAS.


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