Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: B. Haws

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), K. Cardinal(1), J. Guntin(1), M. Colman(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: MIS surgery has increased in popularity due to proposed advantages in the perioperative and immediate postoperative periods. However, patient preferences and understanding regarding the differences between MIS and open surgery have not been elucidated.

Objective: To describe patient perceptions of minimally invasive (MIS) versus open surgery, and to determine which factors are most heavily considered by the patient when choosing between approaches.

Methods: An anonymous questionnaire consisting of 30 questions was administered to patients scheduled to see either an MIS surgeon or an open spine surgeon for a clinical evaluation. 6 questions asked about patient demographics and medical history. 9 questions asked respondents to rate the importance of several criteria when deciding between MIS and open surgery. 15 multiple choice and free response questions asked respondents about their perceptions of MIS versus open surgery in regards to surgical and physician characteristics. Subgroup comparison was performed for survey responses between patients seeing a MIS surgeon and patients seeing an open spine surgeon. Statistical analysis used to compare patient responses consisted of linear regression adjusted for demographic differences and chi-square analysis or Fisher's exact test for continuous and categorical variables, respectively

Results: 326 patients completed the survey. The three most important criteria for patients when choosing between open and MIS surgery were: long-term outcomes, surgeon's recommendation, and complication risk for both MIS and open subgroups. When compared to MIS surgery, the majority of patients perceived open surgery to be more painful (83.8%), have increased complication risk (78.5%), have increased recovery time (89.3%), have increased costs (68.1%) and require heavier sedation (62.6%). If required to have spine surgery in the future, the majority of both patient groups would prefer a minimally invasive approach (80.0%).

Conclusion: Long-term outcomes, surgeon's recommendation, and complication risk were the most important criteria identified by patients when choosing between open and MIS surgery. Patients also perceived MIS surgery to have advantages over open surgery in regards to postoperative pain, complication risk, recovery time, cost, and anesthesia requirement. Most patients, regardless of their surgeon's preferred technique, appear to prefer a minimally invasive approach to their treatment.

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