The Relationship between Preoperative Expectations and the Short-Term Postoperative Satisfaction and Functional Outcome in Lumbar Spine Surgery: A Systematic Review

Abstract

Study Design Systematic review. Objective To examine the relationship between the patient's preoperative expectations and short-term postoperative satisfaction and functional outcome in lumbar spine surgery. Methods The Medline, Embase, and Cochrane databases were queried using a predefined search algorithm to identify all lumbar spine studies analyzing the influence of preoperative expectations on postoperative satisfaction and functional outcome. Two independent reviewers and a third independent mediator reviewed the literature and performed study screening, selection, methodological assessment, and data extraction using an objective protocol. Results Of 444 studies identified, 13 met the inclusion criteria. Methodological quality scores ranged from 59 to 100% with the greatest variability in defining patient characteristics and the methods of assessing patient expectations. Patient expectations were assessed in 22 areas, most frequently back and leg pain expectations and general expectations. Functional outcome was assessed by 13 tools; the most common were the visual analog scale, Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Positive expectations for symptomatology, activity, general health, and recovery correlated with satisfaction. General expectations correlated with higher SF-36 Physical Subcomponent scores, better global function, and lower ODI outcome. Conclusions on the influence of the expectations for pain were limited due to the study heterogeneity, but the evidence suggests a positive correlation between the expectation and outcome for back and leg pain. Conclusions Positive expectations correlated significantly with short-term postoperative satisfaction and functional outcome, including higher SF-36 scores, earlier return to work, and decreased ODI scores. Future expectation-based investigations will benefit from implementation of the standardized methods of expectation, satisfaction, and outcome analysis discussed herein.

Patients’ Expectations on Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Qualitative Exploration

“…The attitude of the patient prior to SCS and other psychological factors seem to be correlated with the outcome of SCS . Various studies have discussed the importance of addressing pain‐related expectations with patients before surgery through conversations with surgeons and through formal patient education meetings as these expectations are potentially modifiable …”

“…[29][30][31] Various studies have discussed the importance of addressing pain-related expectations with patients before surgery through conversations with surgeons and through formal patient education meetings as these expectations are potentially modifiable. [16][17][18] Expectations with Regard to Daily Activities, Including Walking…”

“…Next to pain relief, QoL is an important outcome measurement in the treatment of chronic pain . Previous research illustrates that patients’ expectations are associated with postoperative satisfaction and functional outcome in lumbar spine surgery . These studies suggest addressing pain‐related expectations before surgery and highlight the importance of conveying information about realistic expectations.…”

“…[13][14][15] Previous research illustrates that patients' expectations are associated with postoperative satisfaction and functional outcome in lumbar spine surgery. [16][17][18] These studies suggest addressing pain-related expectations before surgery and highlight the importance of conveying information about realistic expectations. Furthermore, patients' expectations from SCS may be understated; thus, there remains a possibility of dissatisfaction even when expectations are met.…”

Complication avoidance with pre-operative screening: insights from the Seattle spine team

“…Ellis et al conducted a meta-analysis of studies investigating the link between preoperative patient expectations (pain expectations and general expectations) and their functional outcome after lumbar spine surgery. Patient expectations that were more positive prior to surgery were significantly associated with better postoperative functional outcomes [31]. Mendez et al conducted a study investigating the associations between preoperative diagnoses of psychiatric conditions and postoperative negative outcomes.…”