Purpose The majority of studies of surgical outcome
focus on measures of function and pain. Increasingly,
however, the desire to include domains such as patients’
satisfaction and expectations had led to the development of
simple measures and their inclusion into clinical studies.
The purpose of this study was to determine patients’ preoperative
expectations of and post-operative satisfaction
with the outcome of their spinal surgery.
Methods As part of the FASTER randomised controlled
trial, patients were asked pre-operatively to quantify their
expected improvement in pain and health status at 6 weeks,
6 and 12 months following surgery using 100 mm visual
analogue scales (VAS), and to indicate their confidence in
achieving this result and also the importance of this
recovery to them. Patients were then asked to rate their
satisfaction with the improvement achieved at each postoperative
review using 100 mm VAS.
Results Although differences between patients’ expectation
and achievement were minimal 6 weeks post-operatively,
there was a clear discrepancy at 6 months and
1 year, with patient expectations far exceeding achievement.
There were significant correlations between failure to
achieve expectations and the importance patients attached
to this recovery at each post-operative assessment, but not
with their confidence in achieving this result. Satisfaction
levels remained high despite expectations not being met,
with discectomy patients being more satisfied than
decompression patients.
Conclusions Patients’ pre-operative expectations of surgical
outcome exceed their long-term achievement. The
more importance the patient attached to a good outcome,
the larger is the discrepancy between expectation and
achievement. Despite this, satisfaction levels remained
high. The impact of unrealistic expectations on outcome
remains unclear.