9:20 Correlation of patient and physician assessment of outcome for fusion in the treatment of lumbar degenerative disc disease

Abstract Purpose of study: The purpose of this study was to examine patient and physician assessment of outcomes in patients undergoing fusion procedures of lumbar degenerative disc disease. Methods used: The National Spine Network (NSN) database was examined for patients who had undergone fusion procedures as treatment for a primary diagnosis of lumbar degenerative disc disease. Patients required preoperative and at least 1-year postoperative Short Form (SF)-36, Oswestry Disability Index and physician and patient subjective assessment of improvement data. Data were obtained and examined regarding correlation between patient and physician interpretation of a successful outcome. of findings: Information on 35 patients meeting criteria was obtained from the NSN database. Procedures included 19 anterior lumbar interbody fusions, 11 posterior lumbar interbody fusions and 5 circumferential fusions. Physician assessment included 16 patients with "major improvement," 16 "minor improvement" and 3 "no change." No patients were evaluated as worse. Patient assessment showed 4 "much better," 10 "somewhat better," 12 "about the same," 7 "somewhat worse" and 2 "much worse." Physician-interpreted outcomes of "major improvement" and patient determination of "much better" was compared. Similarly, "minor improvement" and "somewhat better" were also compared. Overall, patient versus physician rating of clinical outcome revealed poor correlation (kappa 0.02). Bodily Pain: The mean subset improvement in the 16 patients with "major improvement" by physician evaluation was 30.3. Four patients who self assessed themselves as "much improved" had a mean score of 59.5. Physician-evaluated "minor improvement" patients (n=16) had a mean of 2.2 compared with the patients who assessed themselves as "somewhat better" (n=10) who had a mean of 26.3. Physical Function: The mean subset improvement in the 16 patients with "major improvement" by physician evaluation was 30.5. Four patients who assessed themselves as "much improved" had a mean improvement of 41.7. Physician-determined "minor improvement" patients (n=16) had a mean improvement of 15.3 compared with the "somewhat better" patient assessment group (n=10) of 31.7. Oswestry Disability Index: Mean improvement in the 16 patients with "major improvement" by physician evaluation was 25.2 The four patients self-assessed as "much improved" had a mean improvement of 38.3. Physician-determined "minor improvement" patients (n=16) had a mean improvement of 6.9 versus the self-assessed "somewhat better" patients (n=10) whose mean improvement was 20.8. Relationship between findings and existing knowledge: The findings of this study reveal differences between patient and physician measurement of success. This relationship has been documented in other disease processes and surgical procedures but to our knowledge not examined in this group. Overall significance of findings: The data reveal a wide discrepancy between patient and physician interpretation of what constitutes a successful outcome. The discrepancy holds true throughout the examined SF-36 and Oswestry Disability Index data examined as poor correlation was throughout all parameters studied. The results highlight the need for more study of this disease process and its treatment as well as the differences between patient and physician assessments of outcomes. The acceptance of successful results must be considered from the viewpoint of the interpreting physician and the needs of the patient. Disclosures: No disclosures. Conflict of interest: No conflicts.