Determinants of Patient Satisfaction Two Year after Spinal Deformity Surgery: A Latent Class Analysis.

STUDY DESIGN: Retrospective review of prospective multicenter database.

OBJECTIVE: To investigate the determinants of patient satisfaction with respect to changes in functional limitations two-year after spinal deformity surgery.

SUMMARY OF BACKGROUND DATA: For operatively treated adult spine deformity (ASD), patient satisfaction has become an important component of evaluating quality of care.

METHODS: 430 operative ASD patients with two-year follow-up were analyzed. Patient satisfaction was assessed using the Scoliosis Research Society 22-item (SRS-22r). Latent class analysis (LCA) was performed to assign individuals to classes based on the changes in pre- and 2-year post-operative functions, assessed using the Oswestry Disability Index (ODI). An ordered logistic regression was conducted to assess the association of class membership and satisfaction.

RESULTS: LCA identified 4 classes. The worsened-condition class (WC: 1.4%) consisted of patients who were likely to experience worsened function, particularly in lifting and pain intensity. The remained-same class (RS: 13.0%) included patients who remained the same, as the majority reported approximately no change in walking, standing and sitting. The mild-improved class (Mild-I: 40.2%) included patients with mildly enhanced conditions, specifically, in standing, social life and employment. The most-improved class (Most-I: 45.3%) included patients with great improvement after surgery mainly in standing, followed by social life and employment. The odds of being satisfied were significantly increased by 3.91-(p < 0.001) and 16.99-fold (p < 0.001), comparing patients in Mild-I and Most-I to the RS/WC class, respectively, after controlling for confounders.

CONCLUSIONS: Improvement in standing, social life and employment are the most important determinants of patient satisfaction post-surgery. Reduced pain intensity and enhanced walking ability also help to elevate patient satisfaction. However, lifting, personal care, sitting, sleeping and travelling may be of less importance. Examining the heterogeneity of patient-reported outcome in ASD patients allows the identification of classes with different patient characteristics and satisfaction, and thus, help to guide tailored provision of care.

LEVEL OF EVIDENCE: 4.