Introduction: Satisfaction score have become a major tool in assessing the quality of surgical spine care. We set out to determine the impact of baseline and 12-month modified Japanese Orthopedic Association scores (mJOA) on satisfaction with surgery for cervical myelopathy.
Methods: Patients undergoing surgery for cervical spondylotic myelopathy were queried from prospective multicenter quality outcomes database (QOD). Baseline and 12-month mJOA scores were recorded. Satisfaction at 12-month after surgery was measured using the NASS questionnaire. Multivariate proportional odds regression analysis was conducted to determine the impact of mJOA scores on satisfaction.
Results: Of 820 total patients, 64% (n=522) were felt that surgery met their expectations (NASS level 1) at 12-months. After adjusting for baseline and surgery-specific variables, 12-month mJOA score had the highest impact (Wald ?2=51.8, 48% of the total ?2) on satisfaction. Satisfaction increased with increasing 12-month mJOA, and a greater mJOA improvements were required to achieve satisfaction in patients with lower baseline mJOA scores (Figure 1). Other predictors include diabetes, age, occupation, and duration of symptoms (Figure 2). Baseline mJOA scores had relatively little impact on satisfaction (Wald ?2=0.77, <1% of the total ?2).
Conclusions: Of a total of 820 patients, 64% (n=522) were satisfied at a level wherein surgery met their expectations (NASS level 1) at the one year mark. After adjusting for baseline and surgery-specific variables, 12-month mJOA score had the highest impact (Wald ?2=51.8, 48% of the total ?2) on satisfaction. The level of satisfaction was found to increase with increasing 12-month mJOA score, and a greater improvement in mJOA was required to achieve satisfaction in patients with lower baseline mJOA scores (Figure 1). Other predictors in descending order of impact include diabetes, age, occupation, and duration of symptoms (Figure 2). Baseline mJOA scores had relatively little impact on satisfaction (Wald ?2=0.77, <1% of the total ?2).
Patient Care: Developing quality metrics that are tailored to the nuances of specific spine pathologies is a prerequisite for accurately measuring and improving care. This study establishes such a foundation for cervical myelopathy surgery, by revealing that mJOA must be used in conjunction with satisfaction scores to correctly assess the quality o care. The application of this insight to real world care will improve the accuracy of quality assessments for cervical myelopathy surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of satisfaction scores in assessing the quality of spine surgery, 2) Discuss the impact of baseline and 12-month mJOA scores on satisfaction after surgery for cervical myelopathy, and 3) Explain the phenomenon wherein patients with severe myelopathy require larger mJOA improvements to achieve satisfaction.