Medical Student Hackensack-Meridian School of Medicine Chatham, New Jersey, United States
Introduction: Studies have shown no difference between fusion and decompression in long term postoperative functional outcomes of surgical treatment of grade I lumbar spondylolisthesis. Additionally, most patients have been shown to be satisfied with their procedures in both treatment groups. Physician reimbursement in spine surgery by Centers for Medicare & Medicaid Services (CMS) is being increasingly driven by patient experience. In hopes of improving patient experience and maximizing physician reimbursement for procedures, the authors analyzed contributing factors of postoperative patient satisfaction.
Methods: The authors queried the Quality Outcomes Database (QOD) of a single practice for spondylolisthesis patients who underwent decompressions. Comorbidities and baseline, 12-month and 24-month patient-reported outcomes (PROs) were compiled for ODI, NRSLP, NRSBP, and North American Spine Surgery Patient Satisfaction Index (PSI).
Results: A total of 50 patients with at least 24 month follow up were identified. At 12 months 72% of patients were satisfied; at 24 months 64% of patients were satisfied (p= 0.39). No difference in satisfaction was observed in regards to patient age, comorbidities, or baseline disability at either interval. Higher improvement in NRSBP and ODI was seen in satisfied patients. Patients with a BMI below 32 saw higher satisfaction (OR: 4.32, 95% CI: 1.14 - 16.37). Male patients were less likely to be satisfied at 24 months (OR: 0.31, 95% CI: 0.11 - 0.86). Furthermore, no difference in likelihood of satisfaction was observed between patients that underwent decompression and fusion (OR: 0.73, 95% CI: 0.19 - 2.82). Notably, 8 patients that became unsatisfied between 12 and 24 months had significantly lower BMIs and baseline NRSBP, NRSLP, and ODI than satisfied patients. Moreover, of the 3 patients that gained satisfaction between 12 and 24 months, 2 underwent reoperation procedures.
Conclusion : This study found associations between long-term higher satisfaction with lower preoperative BMI and female gender. Unlike previous studies, we find that fusion procedures do not significantly increase postoperative satisfaction. Further analysis is warranted to elucidate the causes of patients becoming unsatisfied between 12 and 24 months, despite demonstrating lower baseline disability and pain.
How to Improve Patient Care: This work seeks to identify factors that can improve patient outcomes following procedures for spondylolisthesis.
