Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis

Insights from the Quality Outcomes Database

Praveen V. Mummaneni, Mohamad Bydon, Mohammed Ali Alvi, Andrew K. Chan, Steven D. Glassman, Kevin Foley, Eric A. Potts, Christopher I. Shaffrey, Mark E. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Michael Y. Wang, Kai Ming Fu, Jonathan R. Slotkin, Anthony L. Asher, Michael S. Virk, Panagiotis Kerezoudis, Jian Guan, Regis W. Haid & 1 others Erica F. Bisson

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Since the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the "value"-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1-4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom. RESULTS A total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5-9] vs 8 [6-9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09-2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27-3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30-4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome. CONCLUSIONS Current findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

Original languageEnglish (US)
Article numberE12
JournalNeurosurgical focus
Volume46
Issue number5
DOIs
StatePublished - Jan 1 2019

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Spondylolisthesis
Patient Satisfaction
Databases
Logistic Models
Decompression
Leg
Spine
Patient Protection and Affordable Care Act
Pain
Registries
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis : Insights from the Quality Outcomes Database. / Mummaneni, Praveen V.; Bydon, Mohamad; Alvi, Mohammed Ali; Chan, Andrew K.; Glassman, Steven D.; Foley, Kevin; Potts, Eric A.; Shaffrey, Christopher I.; Shaffrey, Mark E.; Coric, Domagoj; Knightly, John J.; Park, Paul; Wang, Michael Y.; Fu, Kai Ming; Slotkin, Jonathan R.; Asher, Anthony L.; Virk, Michael S.; Kerezoudis, Panagiotis; Guan, Jian; Haid, Regis W.; Bisson, Erica F.

In: Neurosurgical focus, Vol. 46, No. 5, E12, 01.01.2019.

Research output: Contribution to journalArticle

Mummaneni, PV, Bydon, M, Alvi, MA, Chan, AK, Glassman, SD, Foley, K, Potts, EA, Shaffrey, CI, Shaffrey, ME, Coric, D, Knightly, JJ, Park, P, Wang, MY, Fu, KM, Slotkin, JR, Asher, AL, Virk, MS, Kerezoudis, P, Guan, J, Haid, RW & Bisson, EF 2019, 'Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: Insights from the Quality Outcomes Database', Neurosurgical focus, vol. 46, no. 5, E12. https://doi.org/10.3171/2019.2.FOCUS18734
Mummaneni, Praveen V. ; Bydon, Mohamad ; Alvi, Mohammed Ali ; Chan, Andrew K. ; Glassman, Steven D. ; Foley, Kevin ; Potts, Eric A. ; Shaffrey, Christopher I. ; Shaffrey, Mark E. ; Coric, Domagoj ; Knightly, John J. ; Park, Paul ; Wang, Michael Y. ; Fu, Kai Ming ; Slotkin, Jonathan R. ; Asher, Anthony L. ; Virk, Michael S. ; Kerezoudis, Panagiotis ; Guan, Jian ; Haid, Regis W. ; Bisson, Erica F. / Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis : Insights from the Quality Outcomes Database. In: Neurosurgical focus. 2019 ; Vol. 46, No. 5.
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abstract = "OBJECTIVE Since the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the {"}value{"}-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1-4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom. RESULTS A total of 502 patients, out of a cohort of 608 patients (82.5{\%}) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5{\%}, n = 113) or 1-level decompression and fusion (77.5{\%}, n = 389), met the inclusion criteria; of these, 82.1{\%} (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7{\%}, n = 172, vs 24.4{\%}, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1{\%}, n = 95, vs 11.1{\%}, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5-9] vs 8 [6-9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95{\%} CI 1.09-2.76; p = 0.009), preoperative active employment (OR 2.06, 95{\%} CI 1.27-3.67; p = 0.015), and fusion surgery (OR 2.3, 95{\%} CI 1.30-4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome. CONCLUSIONS Current findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.",
author = "Mummaneni, {Praveen V.} and Mohamad Bydon and Alvi, {Mohammed Ali} and Chan, {Andrew K.} and Glassman, {Steven D.} and Kevin Foley and Potts, {Eric A.} and Shaffrey, {Christopher I.} and Shaffrey, {Mark E.} and Domagoj Coric and Knightly, {John J.} and Paul Park and Wang, {Michael Y.} and Fu, {Kai Ming} and Slotkin, {Jonathan R.} and Asher, {Anthony L.} and Virk, {Michael S.} and Panagiotis Kerezoudis and Jian Guan and Haid, {Regis W.} and Bisson, {Erica F.}",
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TY - JOUR

T1 - Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis

T2 - Insights from the Quality Outcomes Database

AU - Mummaneni, Praveen V.

AU - Bydon, Mohamad

AU - Alvi, Mohammed Ali

AU - Chan, Andrew K.

AU - Glassman, Steven D.

AU - Foley, Kevin

AU - Potts, Eric A.

AU - Shaffrey, Christopher I.

AU - Shaffrey, Mark E.

AU - Coric, Domagoj

AU - Knightly, John J.

AU - Park, Paul

AU - Wang, Michael Y.

AU - Fu, Kai Ming

AU - Slotkin, Jonathan R.

AU - Asher, Anthony L.

AU - Virk, Michael S.

AU - Kerezoudis, Panagiotis

AU - Guan, Jian

AU - Haid, Regis W.

AU - Bisson, Erica F.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE Since the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the "value"-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1-4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom. RESULTS A total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5-9] vs 8 [6-9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09-2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27-3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30-4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome. CONCLUSIONS Current findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

AB - OBJECTIVE Since the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the "value"-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1-4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom. RESULTS A total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5-9] vs 8 [6-9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09-2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27-3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30-4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome. CONCLUSIONS Current findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

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