Spinal Surgery: Patient Satisfaction Linked to Factors Unrelated to Care

Insurance status and initial severity of symptoms may impact satisfaction scores after spinal surgery, Vanderbilt researchers found.

Insurance status and initial severity of symptoms may impact satisfaction scores following spinal surgery.

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To identify pre-operative factors that may influence patient satisfaction, researchers from Vanderbilt University in Nashville surveyed 1,645 spinal surgery patients. The patients filled out a standard rating scale for disability and neck, back, arm, and leg pain before undergoing surgery for degenerative cervical and lumbar diseases. They repeated the survey one year later.

They also had patients fill out the North American Spine Society Satisfaction Questionnaire at the one-year mark. They found that 83% were satisfied with their outcomes.

Clinton J. Devin, MD, and colleagues identified several specific predictors of dissatisfaction. Perhaps not surprisingly, patients who did not achieve at least a 15% improvement in disability were four times more likely to be unhappy with their results. This benchmark is considered the minimal improvement to be clinically significant.

Likewise, those who saw less than the clinical minimum on a pain-rating scale were three times more likely to be dissatisfied.

Lack of health insurance or being on Medicaid, as well as high levels of initial pain and disability, also contributed to lower satisfaction, regardless of improvement. Depression and anxiety before surgery appeared to have reduced improvement and satisfaction scores, but after adjusting for initial pain scores, these factors did not prove to be significant.

Under the Affordable Care Act, patient satisfaction scores are being used as a measure of the quality of medical care and a determinant of reimbursement. Increasingly, insurers are using patient satisfaction metrics to measure health care services and quality of care.

The study may help identify patients who are at risk of dissatisfaction with surgery and lead to finding ways to improve their experience. “Individualizing the patient preoperative counseling on the basis of these patient-specific factors can improve patient satisfaction with outcomes,” they wrote in the August 2015 issue of Neurosurgery.