Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years − score at baseline) data.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49–0.55), and function (r = 0.41–0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r &lt; 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (&lt; 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (&gt; 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (&lt; 30%; OR 2.68), SRS-22R pain (&lt; 50%; OR 3.25) and SI/appearance (&lt; 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (&lt; 2 cm; OR 3.16) were associated with low satisfaction.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.</jats:p></jats:sec>

Importance of achieving Scoliosis Research Society–22r minimal clinically important difference for improving patient satisfaction after adult spinal deformity surgery

“…An increasing emphasis is being placed on providing patient-centered care, and the phrase "patient satisfaction" is used increasingly in the medical literature. 31,33,34 It is important to identify the factors that affect patient satisfaction because of the wide range of symptoms in patients with ASD, including dysfunction, pain, poor self-image, mental disorder, and visceral disorders. In this study, we examined the patient-related, radiographic, HRQOL, and surgical factors associated with patient satisfaction after extensive corrective fusion surgery for ASD.…”

“…Similar past studies were multicenter studies. 31,33,34 There are many cases from multicenter research, but it is difficult to compare these cases because of the different surgical indications and different surgical methods. This study was a single-institution study, and surgical indications, surgical methods, and postoperative physical therapies were consistent.…”

Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively

“…25 The improvement of clinical outcomes after corrective surgery for ASD is also related to improved patient satisfaction. 26 Because of the large number of implants used in corrective fusion surgery for ASD, medical costs are not low. 22,27 However, as shown in the results of this study, corrective fusion can improve and maintain the PROs in patients with ASD over the mid-to long-term.…”

The Comparison of Spinopelvic Parameters, Complications, and Clinical Outcomes After Spinal Fusion to S1 with or without Additional Sacropelvic Fixation for Adult Spinal Deformity

“…15 As a measurement of sagittal spinal balance, an increase in the SVA of <2 cm from baseline is associated with lower satisfaction. 28 Most of the included studies revealed that both groups showed an improvement in sagittal balance postoperatively. 15,17,19 In our pooled analysis, the SVA was similar between the two groups at the last follow-up, which was different from that in the study by Yasuda et al 17 The inevitable postoperative decompensation in the sagittal position leads to the overall loss of sagittal balance, 3 which is the reason for the lack of a significant difference in the follow-up SVA measurement.…”