Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: J. Yang


J. Yang(1,2), V. Lafage(1), R. Lafage(1), J. Smith(3), E. Klineberg(4), C. Shaffrey(3), G. Mundis(5), R. Hostin(6), D. Burton(7), C. Ames(8), S. Bess(9), F. Schwab(1), International Spine Study Group (ISSG)

(1) Hospital for Special Surgery, New York, NY, United States
(2) Columbia University, Mailman school of Public Health, Department of Epidemiology, New York, NY, United States
(3) University of Virginia, Charlottesville, VA, United States
(4) University of California, Davis, Sacramento, CA, United States
(5) San Diego Center for Spinal Disorders, La Jolla, CA, United States
(6) Baylor Scoliosis Center, Plano, TX, United States
(7) University of Kansas Medical Center, Kansas City, KS, United States
(8) University of California, San Francisco, San Francisco, CA, United States
(9) Denver International Spine Center, Denver, CO, United States


Background: For patients receiving operative management for adult spine deformity (ASD), patient satisfaction has become an important component of evaluating quality of care. However, little is known regarding the determinants of patient satisfaction.

Purpose: To investigate the determinants of patient satisfaction from a patient-reported outcome perspective one year after spinal deformity surgery.

Study Design/Setting: This is a multicenter retrospective review of prospectively collected cases.

Patient Sample: The study included operative ASD patients.

Outcome Measures: Patient satisfaction was assessed using the Scoliosis Research Society 22-item (SRS-22r).

Methods: Data from 585 patients across 11 centers within the United States who underwent spinal deformity surgery and had a one year follow-up was collected. Changes in pre- and 1 year post-operative scores were obtained using the Oswestry Disability Index (ODI). Latent class analysis was performed to assign individuals to classes on a probabilistic basis using the changes in 10 items from ODI. Multinomial logistic regression was conducted to assess the association of class membership and patient satisfaction.

Results: Latent class analysis that compared the pre- and 1-year post-operative ODI identified 4 classes of satisfaction (based on SRS-22r). The most unsatisfied class (7%) consisted of patients who were likely to experience worsened conditions after surgery, particularly in lifting, social life and employment. Unsatisfied class (32%) consisted of patients likely to remain the same after the surgery; the majority reported approximately no change in their personal care, walking, social life and employment. Satisfied class (50%) was composed of patients who had mildly enhanced conditions after surgery; more specifically major improvement in standing, pain intensity, social life and employment was observed. The most satisfied class included (11%) patients who have experienced great improvement due to surgery. Largest improvement was seen in standing, followed by social life, walking, pain intensity and employment among most satisfied patients. The relative risk of being very satisfied was significantly increased by 10.79 (p=0.003) and 25.50 (p=0.009) times, comparing the patients in satisfied class and the most satisfied class to the most unsatisfied, respectively.

Conclusions: Improvement in social life and employment are most important determinants of patient satisfaction after surgery. Reduced pain intensity, enhanced walking and standing also help to elevate patient satisfaction. However, lifting, personal care, sitting, sleeping and travelling may of less importance. Examining the heterogeneity of patient-reported outcome in ASD patients allows the identification of classes with different patient characteristics and satisfaction, and thus, guides tailored and patient-centered provision of surgical care.