WHICH ARE PATIENTS EXPECTANCIES BEFORE SURGERY TO TREAT DEGENERATIVE LUMBAR DISEASE?

Abstract

Study Design: A prospective observational study including 43 patients who underwent surgery for degenerative lumbar disease.

Objective: The purpose of this study was to know wich were the expectancies about improvement of patients who underwent a degenerative lumbar disease surgery.

Materials and Methods: Patients with a surgical indication for a degenerative lumbar disease, and followed by spine surgery unit of our insitution, were included. During the day before surgery, Health related quality of life mesures were administrated including SF-36, Oswestry Disability Index (ODI) and a questionnaire adapted to know which ones were our patients preoperative expectancies and the grade of unsatisfaction in case they didn’t accomplish those expectancies after surgery.

Results: 43 patients (22 male, 21 female) were included. Age average was 54 years (rang 22–83), average preoperative ODI value was 48,14 (SD 22’4) and average expected value was 13,14 (SD12,1), with an average of improvement of 72’8% (SD 24’8). Diagnose of estenosis with neurological simptoms was the only parameter associated to improvement in front of isolated low back pain (66,0 SD 29’3; 79’6 SD 17’6 p=0’26%). Previous state, gender, age, SF-36 scores were’nt globaly related to expectancies.

‘Pain’ and ‘to seat’ expectancies were worse in females (r= 0’40 p= 0’023). Age was associated to ‘to lift weight’(r=0’337 p= 0’041), ‘to travel’ (r=0’513 p=0’001) and borderline for ‘sexual activity’ (r=0’315 p= 0’061).

Mental SF-36 score was inversely associated to ‘pain intensity’ (r=−0’449 p= 0’013) and ‘sexual activity’ (r=−0’362 p=0’05). Patients included in our study didn’t expect any improvement for subjects as ‘Personal care’, ‘to sleep’ and ‘to lift weight’ (p=0’9 p=0’2 y p=0’7).

In the group fo workers (16 individuals, 47% of sample), the grade of unsatisfaccion in case of not to be able to return to their occupation, was low. This result was independant to age, gender and diagnose.

Conclusions: Preoperative expectancies of patients before underwent the same surgery are differents. To know about it using a Health related quality of life mesure wich gives the same especific weight to all activities of daily life without knowing which ones are more importants for our patients (according to age, gender, diagnose, social estatus..) could be a bias to evaluate results and the grade of satisfaction of them. More studies are necessary to know if the accomplishment of those expectancies affects the final result of surgery.