81. Do patient expectations represent a more important clinical difference: a study of surgical outcomes in the cervical spine

BACKGROUND CONTEXT Minimum clinically important difference (MCID) has been lauded as a more relevant assessment of postoperative outcomes. However, patient expectations have also gained attention as an indicator for patient satisfaction. PURPOSE To compare the impact of achieving an MCID or meeting preoperative expectations on patient satisfaction following cervical spine procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Seventy-seven patients undergoing primary or revision, single- or multilevel cervical disc replacement or anterior cervical discectomy and fusion (ACDF). OUTCOME MEASURES Demographic and perioperative characteristics, visual analogue scale (VAS) neck and arm. METHODS A database was reviewed for patients undergoing primary or revision, single- or multilevel cervical disc replacement or ACDF. Demographic and perioperative characteristics were collected and descriptive statistics were performed. Patients’ expectations for postoperative neck and arm pain were assessed preoperatively on a scale from 1-10. Visual analogue scale (VAS) neck and arm pain was assessed at preoperative and postoperative (6-week, 12-weeks, 6-months, 1-year) timepoints. Patient satisfaction regarding their current level of neck and arm pain was recorded at each postoperative timepoint. “Meeting expectations” was defined as postoperative VAS arm and neck scores equaling preoperative expectation scores. Achievement of MCID was determined using the following previously established values: VAS neck ≥ 2.6, VAS arm ≥ 4.1. Linear regression was used to determine if meeting expectations or achieving MCID were predictors of postoperative satisfaction. Differences in effect sizes of expectations met and MCID achievement as predictors of satisfaction were directly compared. RESULTS Of 77 patients, the cohort had a mean age of 48.8 years, was 40.3% female and 44.0% obese. Myeloradiculopathy was the most common preoperative spinal diagnosis (88.3%) and a majority of patients underwent ACDF (57.1%). Most procedures took place at a single level, mean operative time was 58.0 minutes and mean blood loss was 28.6 mL. Mean preoperative VAS arm and neck were 4.6 and 3.4, respectively. Mean satisfaction ranged from 6.4-7.5 for arm pain and 6.6-7.5 for neck pain. A majority of patients met expectations for arm pain through 6-months and at 12-weeks and 1-year for neck pain. A majority of patients met MCID for VAS neck through 6-months, but at no timepoints for VAS arm. Meeting expectations for arm and neck pain was a significant predictor of satisfaction at all timepoints except 6-months (all p≤0.003). Achieving MCID significantly predicted postoperative satisfaction at 6-weeks and 12-weeks for arm pain (both p≤0.013) and at 12-weeks and 6-months for neck pain (both p≤0.044). Meeting expectations was a significantly stronger predictor of satisfaction than MCID for both arm and neck pain at 1-year (p=0.007, p=0.012). CONCLUSIONS Both MCID achievement and meeting expectations for VAS arm and neck were significant predictors of satisfaction at short-term timepoints. However, meeting expectations was the only significant predictor of satisfaction at 1-year. This suggests patient expectations may be a more valuable metric for assessing patient perceptions of long-term pain improvement following cervical spine procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs