Morlock RJ, Nerenz DN, Ward RE; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented By: Robert J. Morlock, M.A., Center for Health Services Research, Henry Ford Health System, 1 Ford Place - 3A, Detroit, MI 48202. Tel: (313) 874-5454. Fax: (313) 874-1883. E-mail: RMORLOC1@HFHS.ORG
Research Objective: The literature reports a wide range of success rates for low-back surgery. Given this variation, our objective was to determine the accuracy of spine surgeons' predictions of successful surgical outcomes.Study Design: Patients age 18 to 65, presenting as candidates for surgery with a diagnosis of lumbar radiculopathy and no history of low-back surgery, were asked to participate in the study. Enrollment took place at seven spine surgery departments located in the United States including Cleveland Clinic Foundation (Cleveland, OH), Emory Clinic (Atlanta, GA), Henry Ford Health System (Detroit, MI), Lahey Clinic (Burlington, MA), Lovelace Health Systems (Albuquerque, NM), Mayo Clinic (Rochester, MN) and University of New Mexico (Albuquerque, NM). At intake, patients completed a baseline questionnaire that included the Musculoskeletal Outcomes Data Evaluation and Management System's (MODEMS) pain and function instrument to measure overall pain and functional distress. For patients who were offered surgery, the surgeon estimated on a scale of 0 to 100 the probability that the patient would experience an improvement in pain or function one year after surgery. Patients were surveyed again at three and 12 months post surgery. If the patient's MODEMS score improved, the patient was considered to have experienced improvement in pain and function. In this study 29 spine surgeons made predictions on 101 surgical patients.Principal Findings: Surgeons predicted that 37 percent of patients had greater than a 90 percent chance of improvement; 42 percent of patients had between a 80 and 90 percent chance of improvement; and 18 percent of patients had between 70 and 80 percent chance of improvement. Only three percent of patients were given less than a 70 percent chance of improvement. Ninety-five percent of patients that had been predicted to have a 90 percent or higher probability of improvement actually did achieve an improvement. Of those predicted to have an 80-90 percent chance of improvement, 93 percent actually improved. Of those predicted to have a 70-80 percent probability of improvement 72 percent actually improved. Overall, surgeons predicted that 89 percent of patients would improve and 89 percent patients actually reported improvement.Conclusions: For patients who were offered surgery, the surgeon's estimate of probability of success at the time of surgery recommendation was reasonably accurate. Surgeons correctly assessed probability of success for those given a 70 to 80 percent chance of improvement and those given a 90 percent or higher chance of improvement. Surgeons were slightly pessimistic in their probability estimates when they estimated probability of improvement in the 80 to 90 percent range.Implications for policy, delivery or practice: It does not appear in this study that surgeons are inappropriately optimistic about the outcomes that will be achieved, or that surgery is being offered to patients who have a low likelihood of a good outcome. More research is needed to determine if the surgeons' beliefs about likelihood of good treatment outcomes are being effectively communicated to patients. Past research has shown that patient expectations regarding outcomes are directly correlated with their outcome. More research is needed to determine if surgeons are as accurate in predicting success for patients with a prior history of lumbar surgery, making prediction more complex.
Publication Types:
Keywords:
- Cervical Vertebrae
- Digestive System Surgical Procedures
- Humans
- Lumbar Vertebrae
- New Mexico
- Pain
- Pain Clinics
- Pain Measurement
- Physicians
- Postoperative Period
- Questionnaires
- Spinal Fusion
- Spine
- Treatment Outcome
- United States
- surgery
- hsrmtgs
Other ID:
UI: 102272132
From Meeting Abstracts