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J Neurosurg Spine. 2019 Aug 30:1-9. doi: 10.3171/2019.6.SPINE19426. [Epub ahead of print]

Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database.

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1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina.
2Orthopaedics of Steamboat Springs, Steamboat Springs, Colorado.
3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and.
4Department of Biostatistics, Vanderbilt University School of Medicine, and Departments of.
5Neurological Surgery.
6Orthopedic Surgery, and.
7Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.



Patient satisfaction with treatment outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. Nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery are lacking. The authors sought to decipher the impacts of the patient, surgical practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF).


The authors queried the Quality Outcomes Database for patients undergoing 1- to 2-level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed with adjustments for baseline patient characteristics and surgical practice and surgeon characteristics as fixed effects.


A total of 4148 patients (median age 54 years, 48% males) with complete 12-month NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that "surgery met their expectations" (n = 2803), while 20% reported that they "did not improve as much as they had hoped but they would undergo the same operation for the same results" (n = 836). After adjusting for a multitude of patient-specific as well as hospital- and surgeon-related factors, the authors found baseline Neck Disability Index (NDI) score, US geographic region of hospital, patient race, insurance status, symptom duration, and Workers' compensation status to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index 0.66, overfitting-corrected estimate 0.64).


The authors' results found baseline NDI score, patient race, insurance status, symptom duration, and Workers' compensation status as well as the geographic region of the hospital to be the most important predictors of long-term patient satisfaction after a 1- to 2-level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with patients on setting treatment goals and realistic expectations.


ACDF = anterior cervical discectomy and fusion; ASA = American Society of Anesthesiologists; CAD = coronary artery disease; NASS = North American Spine Society; NDI = Neck Disability Index; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; Quality Outcomes Database; anterior cervical discectomy and fusion; neurosurgical registry; prediction; satisfaction


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