Changes in patient-reported outcome measures are associated with expectation fulfilment following elective lumbar spine surgery: an observational study from the Canadian Spine Outcome Research Network (CSORN).

Abstract

Patients' perspectives are central measures of success in healthcare delivery. The association of postoperative changes in patient-reported outcome measures (PROM) and expectation fulfillment is not well established. This study's primary objective was to assess the association between changes in PROMs (e.g., ODI or EQ-5D) and patient multidimensional expectations fulfillment at 1 year following elective lumbar spine surgery. The secondary objectives included measuring changes in PROMs across various levels of expectation fulfillment and identifying the PROM instrument that explains the highest variability in each expectation domain. Retrospective cohort study from the prospectively collected registry data. Data were obtained from the Canadian Spine Outcome Research Network (CSORN) registry, which prospectively enrolls adults undergoing elective spine surgery in Canada. We included adults who underwent elective lumbar spine surgery between January 2015 and December 2022. The study's primary outcome was the extent of expectation fulfillment at one-year follow-up in surgical patients. Demographic, lifestyle, clinical, and multidimensional expectation data were collected using the North American Spine Society Lumbar Spine Questionnaire. Postoperative changes in PROMs were the primary exposure variables. Baseline sociodemographic and clinical characteristics were summarized descriptively, and ordinal logistic regression was used to examine associations between expectation fulfillment and changes in PROMs, adjusting for confounders. We included 6,260 patients. Females represented 50% of the study sample, and the median age was 62 years. The median change in postoperative leg pain scores (NRS) was -6 (-8, -4), -3 (-5, -1), and -1 (-2, 1) points for patients whose expectations were completely met, somewhat met, and unmet, respectively. ODI changed by -28 (-40, -16), -15 (-26, -4), and -4 (-4, 4); p<0.001 for those whose expectations were completely met, somewhat met, and unmet, respectively. PCS scores changed by 16.6 (8.6, 24.1), 8.7 (2.2, 15.2), and 2 (-3.7, 8.6); p<0.001 for patients with expectations that were completely met, somewhat met, and unmet, respectively. A similar association was observed between changes in PROMs and expectation fulfillment in other expectation domains. Changes in the leg pain and back pain score were strongly associated with expectation fulfillment regarding reduction in Leg pain and Back pain, respectively. Similarly, changes in ODI, EQ-5D and SF-12 PCS scores were strongly associated with expectation fulfillment for Improvement in General Physical Capacity. Postoperative changes in PROMs are strongly associated with patient expectation fulfillment following elective lumbar spine surgery at one-year follow-up. Changes in PROMs may provide insights into patients' perceived postoperative outcome. Different PROM instruments reflect distinct aspects of patient experience, with domain- specific alignment between measured outcomes and perceived benefit. While PROM improvements closely mirror patient-perceived success, they do not fully capture expectation fulfillment in all cases.