Patients' expectations of lumbar spine surgery.

Abstract

Patients undergoing lumbar spine surgery are a heterogeneous population and their expectations of surgery are likely to vary depending on individual and group characteristics. Our goal was to assess associations between expectations and demographic, psychological, and clinical characteristics in patients undergoing lumbar spine surgery. Shortly before surgery (mean 7 ± 3 days) 420 patients completed the valid and reliable Hospital for Special Surgery, Lumbar Spine Surgery Expectations Survey, which encompasses physical and psychological expectations; scores range from 0 to 100, higher scores reflect greater expectations. Patients completed additional surveys addressing multiple variables, including disability due to pain with a modified version of the Oswestry Disability Index (ODI). The mean age was 55 ± 15 years, 57 % were men, and most surgery was for painful conditions. The mean Expectations Survey score was 72 ± 20 (range 2.5-100). In multivariate analysis, patients had higher scores (i.e., greater expectations) if they were younger (OR 1.02, CI 1.01, 1.04; p = .002), were not widowed (OR 4.9; CI 1.5, 15.5; p = .007), had prior chiropractic care (OR 1.8; CI 1.1, 2.8; p = .02), had worse ODI scores (OR 2.3; CI 1.5, 3.5; p = .0001), and had worse mental health scores (OR 1.8; CI 1.2, 2.8; p = .006). In additional multivariate analyses, worse ODI score was the clinical variable most closely associated with expecting more Expectations Survey items and expecting more improvement per item. There were wide variations in expectations among patients. Multiple demographic, psychological, and clinical characteristics were associated with expectations, with disability due to pain being the most consistently associated variable.