Introduction: There is general consensus in favor of the management of pre-operative expectations for surgical ASD patients, despite little empirical evidence as to whether future health expectations actually impact HRQOL outcomes. The purpose of this study is to analyze the relationship between HRQOL outcomes following ASD surgery and patients’ general pre-operative health expectations.
Methods: Retrospective analysis of a multi-center, prospective database of surgical ASD patients. General health expectations were measured using question 11c of the SF-36, which asks patients to choose the best of five responses (definitely true to definitely false) to the statement: “I expect my health to get worse.” Responses were grouped into three categories (worse, same, or better health). HRQOL outcomes included the ODI, SRS-22, and the SF-6D. Statistical analysis was performed using ANOVA and regression analysis.
Results: Two-year HRQOL follow-up data were available for 159 of 230 eligible patients (69%). Patients were predominantly female (n=136, 85%) with an average age of 55 (std=15). Table 1 summarizes the average HRQOL measures and QALYs at follow-up by category of general health expectations elicited pre-operatively. There were no significant differences in patient demographics (gender, age, BMI, and Charlson co-morbidity index) or pre-operative radiographic measures (SVA, PT, and Cobb angle) across categories of health expectations (p>0.05). Average HRQOL improvements were lower for patients with higher pre-operative expectations; however, ANOVA and regression analyses indicated that such differences were not statistically significant (p>0.05).
Conclusions: Higher general health expectations were associated with lower average HRQOL improvements following surgery; however, the analysis was unable to show any significant positive or negative impact of general health expectations on post-operative HRQOL outcomes. Additional research should also consider the role of a patient’s expected improvement due to surgery rather than general expectations of overall health.
Patient Care: Improve our understanding of the expectations of patients who seek surgical treatment of adult spinal deformity.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Appreciate the potential importance of pre-operative patient expectations among adults undergoing surgery for spinal deformity; (2) Appreciate the need for future research to more specifically assess the potential role of a patient’s expected improvement due to surgery rather than general expectations of overall health.