The relation between expectations and outcomes in surgery for sciatica

Abstract

OBJECTIVE:To describe the expectations that patients and their physicians have for outcomes after surgical treatment for sciatica and to examine the associations between expectations and outcomes. DESIGN:Prospective cohort study. SETTING ր PATIENTS:We recruited 273 patients, from the offices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians in Maine, who had diskectomy for sciatica. MEASUREMENTS AND MAIN RESULTS:Patients' and physicians' expectations were measured before surgery. Satisfaction with care and changes in symptoms and functional status were measured 12 months after surgery. More patients who expected a shorter recovery time after surgery were "delighted," "pleased," or "mostly satisfied" with their outcomes 12 months after surgery than patients who expected a longer recovery time (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1, 4.4). Also, more patients who preferred surgery after learning that sciatica could get better without surgery had good symptom scores 12 months after surgery than patients who did not prefer surgery (OR 2.9; 95% CI 1.2, 7.0). When physicians predicted a "great deal of improvement" after surgery, 39% of patients were not satisfied with their outcomes and 25% said their symptoms had not improved. CONCLUSIONS:More patients with favorable expectations about surgery had good outcomes than patients with unfavorable expectations. Physicians' expectations were overly optimistic. Patient expectations appear to be important predictors of outcomes, and eliciting them may help physicians identify patients more likely to benefit from diskectomy for sciatica.

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

“…It is interesting that this effect is independent of patients' assessment of their own health, their educational level, emotional state and the intensity of the symptoms, since these factors have been controlled in the study. The research on patients' expectations regarding surgical outcomes in spinal surgery literature is limited, but others have found a relationship between preoperative expectations and the clinical outcome in spinal stenosis [27,31] and disc herniation [40]. It would seem logical that if a patient has lower expectations prior to the surgery; in general, he or she would express higher levels of satisfaction and better clinical results afterwards.…”

Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

“…A variety of factors then mediate this standard, including prior illness, surgery, expectations, amelioration of symptoms and/or disease, and exposures to various external stimuli (e.g., a newspaper article regarding a specific medical condition). [19][20][21] Divergence between the internal standard and a subject's postoperative experiences leads to the conscious development of symptoms [22,23] that persist until recovery is complete. [24] Multiple symptoms (e.g., pain, nausea, physical impairment) of recovery are common to a broad range of surgical procedures across disciplines.…”

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

“…Factors such as personal preference, aversion to medical intervention, and professional recommendations likely affect the decision to undergo treatment. Because patients' perspectives have become a major component of assessing outcome, patients' expectations also have become incorporated in the creation of quality reporting schemes [11,13,20,27,28,37]. Identification of expectations offers tangible participation in a shared decision-making process when an array of different treatment options is available.…”

“…Identification of expectations offers tangible participation in a shared decision-making process when an array of different treatment options is available. Understanding what generates or influences patients' expectations and identifying what patients expect may allow greater convergence of the priorities and goals held by patients and surgeons [13,20,27,28,37]. This may be fundamental to optimizing patient satisfaction.…”