gms | German Medical Science

Objectives: Evaluating the quality of care in elective lumbar surgery often involves considering patient-reported outcomes (PRO). Although postoperative functional improvement, as measured by the Oswestry Disability Index (ODI), is theoretically linked to patient satisfaction, there is conflicting evidence regarding the association. This study aims to elucidate the extent of ODI improvement required to achieve patient satisfaction two years after elective lumbar surgery.

Methods: A retrospective analysis was conducted based on data collected from a single-center prospective cohort study. A total of 383 patients who underwent elective lumbar surgery between 2014 and 2023 were included in the study. Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores greater than or equal 4 considered satisfactory, was evaluated. The study employed receiver operating characteristic (ROC) analysis to determine cut-off values for ODI improvement and postoperative ODI scores indicative of patient satisfaction. Statistical analyses included Mann-Whitney-U and multivariable logistic regression adjusted for age, sex, and BMI, with significance set at p < 0.05.

Results and conclusion: Of the 383 included patients (mean age 65±10 years, 57% female), 23% underwent decompression alone, and 77% underwent fusion and decompression surgery. An improvement in ODI was observed in 91% of patients, with 77% reporting a satisfaction score greater than or equal to 4. Baseline ODI improved from a median score of 62 [IQR 46-74] preoperatively to 10 [IQR 1–10] at 2 years postoperatively. Both baseline (OR 0.98, 95% CI 0.97–1.0, p=0.015) and postoperative ODI scores (OR 0.93, 95% CI 0.91–0.94, p< 0.001), as well as the difference between them (OR 1.04, 95% CI 1.03–1.06 p< 0.001), were significantly associated with patient satisfaction. Attaining an absolute improvement of greater than or equal to 38 ODI points, or 66%, was associated with patient satisfaction, with the latter demonstrating higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). Achieving a postoperative ODI score of 24 or lower was also linked to patient satisfaction, with a sensitivity of 85% and a specificity of 77%.

This study underscores that baseline ODI and improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction two years following lumbar surgery. A percentage improvement in ODI of greater than or equal 66% or reaching a postoperative ODI score of 24 or lower were the most indicative thresholds for predicting patient satisfaction, proving more sensitive and specific than an absolute change of greater than or equal 38 points.