Expectation fulfillment, MCID achievement and postoperative outcomes in elderly patients with degenerative spinal deformity: minimum two-year evaluation.

Abstract

The study aimed to explore the fulfillment of expectations and the minimum clinically important difference (MCID) achievement following surgery by comparing preoperative expectations with 2-year follow-up patient-reported outcomes (PROs) in elderly patients with degenerative spinal deformity (DSD). Preoperatively, all elderly patients with degenerative spinal deformity completed the validated 20-item Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey, alongside the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). At 2 years postoperatively, patients were resurveyed to evaluate expectation fulfillment and MCID achievement. Patients also completed ODI and VAS and reported perioperative events, including subsequent surgeries. Based on expectation fulfillment and MCID achievement, patients were categorized into: Group A: Did not achieve MCID and had unfulfilled expectations. Group B: Achieved MCID with unfulfilled/partially fulfilled expectations or did not achieve MCID with partially/fully fulfilled expectations. Group C: Achieved MCID and fully fulfilled expectations. Also, we conducted a detailed subgroup analysis within Group B to explore potential variations. Of 233 preoperative patients, 200 completed the 2-years follow-up (Group A: 49; Group B: 66; Group C: 85). Demographic and clinical variables did not differ significantly among groups. Group A had longer postoperative hospital stays, higher drainage volumes, and more complications. Multivariable analysis identified factors correlated with unfulfilled expectations and unachieved MCID: higher preoperative expectation counts, spine surgery-related complications, and lesser improvement in low back pain from preoperative to follow-up (all p ≤ 0.05). Better fulfillment of expectations and achievement of MCID was associated with improved clinical outcomes and satisfaction in elderly patients with degenerative spinal deformity at 2 years follow-up. Expectation fulfillment and MCID achievement are influenced by preoperative and postoperative factors, including the magnitude of improvement patients anticipated preoperatively.