From anticipation to achievement: evaluating the impact of preoperative expectations on postoperative patient satisfaction in lumbar decompression surgeries.

Abstract

Patient expectations significantly influence perceived success and satisfaction following spine surgery. While objective metrics assess outcomes, patient-reported outcomes (PROs) are the gold standard for evaluating subjective outcomes and health-related quality of life. Recent studies highlight the complex relationship between preoperative expectations and postoperative satisfaction in spine surgeries. However, the impact of preoperative expectations on PROs for lumbar decompression remains unexplored. The objective of this study was to examine how preoperative expectations influence postoperative satisfaction following lumbar decompression surgery. This prospective cohort study included adults undergoing primary or revision 1- to 2-level lumbar laminectomy or discectomy at a single center between July 2023 and August 2024. PRO measures included the Musculoskeletal Outcomes Data Evaluation and Management Systems instrument, Oswestry Disability Index (ODI), SF-36, and satisfaction (scale 0-100) collected before surgery and 6 weeks, 3 months, and 6 months after surgery. Expectation-outcome mismatch was calculated as preoperative expectation minus postoperative outcome. Multivariable linear regression was used to assess the association between mismatch and satisfaction while adjusting for demographic and clinical covariates. Of 104 enrolled patients, 89 (mean age 64.9 years) were included in this analysis. Preoperative expectation for pain relief was high, with 91% of patients anticipating significant improvement, yet this was achieved postoperatively in only 69%-71%. Lumbar decompression produced substantial functional gains, with the mean ODI score improving from 39.9 ± 17.8 preoperatively to 19.7 ± 19.4 at 3 months, and SF-36 scores showing marked improvement. Expectation-outcome mismatch was the strongest predictor of satisfaction at all time points. Each 10-point increase in mismatch was associated with an approximately 8-point decrease in satisfaction postoperatively at 6 weeks, 3 months, and 6 months (all p < 0.001). No demographic or clinical factors predicted satisfaction at 6 months. Expectation-outcome alignment was the primary determinant of postoperative satisfaction following lumbar decompression. Although patients experienced substantial improvements in disability and quality of life, many did not experience the degree of pain relief they anticipated, and unmet expectations were closely associated with lower satisfaction across all recovery stages. These findings highlight the clinical value of structured realistic preoperative counseling focused on anticipated pain relief, functional recovery, and expected recovery timelines. Incorporating expectation management into routine preoperative discussions might reduce mismatch, improve satisfaction, and support more patient-centered perioperative care.