Medical Student University of California San Francisco San Jose, California, United States
Introduction: Patient satisfaction with treatment is an important quality metric. Here, we studied demographic, surgical, and patient-reported outcomes (PROs) that correlate with patient satisfaction 2 years after surgery for grade 2 spondylolisthesis.
Methods: We queried Prospectively collected data from the Quality Outcomes Database for patients with grade 2 spondylolisthesis. The North American Spine Society Patient Satisfaction Index (NASS) was used to assess satisfaction (Satisfied: NASS score 1 or 2; Unsatisfied: NASS score 3 or 4) at two years. Univariate and multivariate analyses were performed to identify factors that are associated with patient satisfaction.
Results: Overall, 400 patients with grade 2 spondylolisthesis patients were enrolled. Two-year follow-up was 81.3% (325 patients) for satisfaction. There were 289 satisfied (88.9%) and 36 unsatisfied (11.1%) patients. On univariate analysis, satisfied patients had lower rate of depression (20.4% vs 36.1%, p=0.03). there were no differences between satisfied and unsatisfied cohorts in surgical approach, fusion status, and annual reoperation rates (p>0.05). Satisfaction correlated with PROs including reduced disability (Oswestry Disability Index [ODI] scores) (8.8%± 8.8% vs 18.3%±10.1%), reduced numerical rating scale back (NRS-BP) (2.6±2.7 vs. 5.2±3.0) and leg (NRS-LP) (2.0±2.8 vs. 4.1±3.4) pain, and higher quality of life (EQ-5D scores) (0.8±0.19 vs. 0.63±0.2) (all p< 0.001). On multivariate analysis, satisfaction was associated with higher preoperative back pain (OR per 1-pt increase in preop NRS-BP: 1.25 CI: 1.03-1.52) as well as reduced 2-year postoperative NRS- (per 1-pt increase in 24m NRS-BP: 0.82 CI: 0.68-0.99) disability (per 1-pt increase in 24m ODI: 0.91 CI: 0.85-0.98).
Conclusion : Patient satisfaction following grade 2 spondylolisthesis surgery is correlated most with higher levels of preoperative back pain and lower postoperative back pain and disability. Those with higher preoperative back pain have a larger capacity for improvement, driving the increased satisfaction in these patients.
