Patient Regrets Following Surgical intervention in Cervical Spondylotic Myelopathy: An Analysis of Five Year Patient Reported Outcomes within a Single Practice
Medical Student Hackensack-Meridian School of Medicine Chatham, New Jersey, United States
Introduction: Evidence regarding the long-term outcomes of surgical intervention in Cervical Spondylotic Myelopathy (CSM) is critical, as these factors correlate with patient reported outcome measures (PROMs), and thus are indicative of patient quality of life and play a role in physician reimbursement. The objective of this study is to evaluate patient specific factors that may be associated with regret.
Methods: A retrospective analysis of the quality outcomes database (QOD) following surgical intervention for CSM of a high volume private practice in the QOD Study Group was performed. Patient baseline characteristics, socioeconomic descriptors, and PROMs were collected after 12-month, 24-month, and 60-month periods following surgery. Patient regret was measured using NASS Satisfaction, where patient regret was defined as reporting an NASS score of 4.
Results: From the QOD, 63 patients were identified who had up to 60 month follow ups after surgery. 8 of 63 patients reported an NASS score of 4 at 60 months. There was no significant predictor of patient regret by initial presentation and medical comorbidities. Patients with an NASS score of 4 had significantly lower baseline socioeconomic status (SES) than the overall sample (p=0.006). Patients with an NASS score of 4 had significantly higher Neck Disability Indexes (NDIs) at 60 months than satisfied patients (p=0.04), and had significantly lower modified Japanese Orthopaedic Association scale results (MJOAs) at 12-month and 60-month periods than satisfied patients (p=0.02, p=0.04, respectively). Patients with an NASS score of 4 had significantly worse neck pain on a visual analog scale (VAS) (p=0.006).
Conclusion : Notably, patients expressing regret were of significantly lower baseline SES. As expected, these patients reported significantly higher disability at 60 months. Additional strategies should be considered prior to surgery to minimize disparities in satisfaction across SES. Further studies should analyze SES in different practice settings as predictors of postoperative satisfaction. Further studies should investigate measures to support patients in lower SES quartiles.