PMID- 20433291
OWN - NLM
STAT- MEDLINE
DCOM- 20100514
LR  - 20151119
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 12
IP  - 5
DP  - 2010 May
TI  - Comparison of patient and surgeon ratings of outcome 12 months after spine 
      surgery: presented at the 2009 Joint Spine Section Meeting.
PG  - 447-55
LID - 10.3171/2009.11.SPINE09526 [doi]
AB  - OBJECT: The contemporary assessment of spine surgical outcome primarily relies on 
      patient-centered reports of symptoms and function. Such measures are considered 
      to reduce bias compared with traditional surgeon-based outcome ratings. This 
      study examined the agreement between patients' and surgeons' ratings of outcome 1 
      year after spine surgery. METHODS: The study involved 404 patients (mean age 56.6 
      +/- 16.4 years; 259 women, 145 men) and their treating surgeons. At baseline and 
      12 months postoperatively patients completed the Core Outcome Measures Index 
      (COMI) rating pain, function, quality of life, and disability. At 12 months 
      postoperatively, they also rated the global outcome of surgery and their 
      satisfaction with treatment. The surgeon, blinded to the patient's evaluation, 
      rated the global outcome of surgery as excellent, good, fair, or poor. RESULTS: 
      Seventy-six percent of the patients who were considered by the surgeon to have an 
      excellent or good outcome achieved the minimum clinically important difference 
      (MCID) of a 2.2-point reduction on the COMI; 24% achieved less than the MCID. 
      There was a significant correlation between the surgeons' and patients' global 
      outcome ratings (Spearman rho = 0.56; p < 0.0001). The degree of absolute 
      agreement between them was significantly influenced by surgeon seniority: senior 
      surgeons "overrated" the outcome in 24.5% of cases (compared with patients' 
      ratings) and "underrated" it in 17.5% of cases. Junior surgeons overrated in 7.8% 
      of cases and underrated in 43.8% of cases (p < 0.0001). Surgeon overrating 
      occurred significantly more frequently for patients with a poor self-rated 
      outcome (measured as global outcome, COMI score, or satisfaction with treatment). 
      In a multivariate model, the independent variables "senior surgeon" and "patient 
      dissatisfaction with care" were the most significant unique predictors of surgeon 
      overrating of the global outcome (p < 0.0001; adjusted R(2) for the model = 
      0.16). CONCLUSIONS: Overall, agreement between surgeon and patient was reasonably 
      good. The majority of patients who were rated as excellent/good by the surgeons 
      had achieved the MCID in the prospectively measured COMI score. Discrepancies in 
      outcome ratings were influenced by surgeon seniority and patient satisfaction. 
      For a balanced view of the surgical result, outcomes should be assessed from the 
      perspectives of both the patient and the surgeon.
FAU - Porchet, Francois
AU  - Porchet F
AD  - Department of Neurosurgery, Spine Center, Schulthess Klinik, Zurich, Switzerland.
FAU - Lattig, Friederike
AU  - Lattig F
FAU - Grob, Dieter
AU  - Grob D
FAU - Kleinstueck, Frank S
AU  - Kleinstueck FS
FAU - Jeszenszky, Dezso
AU  - Jeszenszky D
FAU - Paus, Christophe
AU  - Paus C
FAU - O'Riordan, David
AU  - O'Riordan D
FAU - Mannion, Anne F
AU  - Mannion AF
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Female
MH  - *General Surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Satisfaction
MH  - Spine/*surgery
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
EDAT- 2010/05/04 06:00
MHDA- 2010/05/15 06:00
CRDT- 2010/05/04 06:00
PHST- 2010/05/04 06:00 [entrez]
PHST- 2010/05/04 06:00 [pubmed]
PHST- 2010/05/15 06:00 [medline]
AID - 10.3171/2009.11.SPINE09526 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2010 May;12(5):447-55. doi: 10.3171/2009.11.SPINE09526.