How much improvement in Oswestry Disability Index is Necessary to make your Patient Satisfied after Lumbar Surgery?

Jan Hambrecht; Paul Köhli; Erika Chiapparelli; Krizia Amoroso; Jiaqi Zhu; Ranqing Lan; Ali E Guven; Gisberto Evangelisti; Marco D Burkhard; Koki Tsuchiya; Roland Duculan; Jennifer Shue; Andrew A Sama; Frank P Cammisa; Federico P Girardi; Carol A Mancuso; Alexander P Hughes

doi:10.1097/BRS.0000000000005044

How much improvement in Oswestry Disability Index is Necessary to make your Patient Satisfied after Lumbar Surgery?

Spine (Phila Pa 1976). 2024 May 21. doi: 10.1097/BRS.0000000000005044. Online ahead of print.

Authors

Jan Hambrecht¹, Paul Köhli^{1

2

3}, Erika Chiapparelli¹, Krizia Amoroso¹, Jiaqi Zhu⁴, Ranqing Lan⁴, Ali E Guven¹, Gisberto Evangelisti^{1

5}, Marco D Burkhard¹, Koki Tsuchiya^{1

6}, Roland Duculan¹, Jennifer Shue¹, Andrew A Sama¹, Frank P Cammisa¹, Federico P Girardi¹, Carol A Mancuso^{7

8}, Alexander P Hughes¹

Affiliations

¹ Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
² Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin, Germany.
⁴ Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
⁵ Instituto Ortopedico Rizzoli, Bologna, Italy.
⁶ Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo Japan.
⁷ Hospital for Special Surgery, New York City, NY, USA.
⁸ Weill Cornell Medical College, New York, NY, USA.

PMID: 38770561
DOI: 10.1097/BRS.0000000000005044

Abstract

Study design: Retrospective review of cohort studies.

Objective: To clarify the necessary ODI improvement for patient satisfaction two years after lumbar surgery.

Background: Evaluating elective lumbar surgery care often involves patient-reported outcomes (PRO). While postoperative functional improvement measured by ODI is theoretically linked to satisfaction, conflicting evidence exists regarding this association.

Methods: Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores ≥4 considered satisfactory, was evaluated. Patients with incomplete follow-up were excluded. Statistical analyses included Mann-Whitney-U and multivariable logistic regression adjusted for age, sex, and BMI. Receiver operating characteristic (ROC) analysis determined threshold values for ODI improvement and postoperative target ODI indicative of patient satisfaction.

Results: 383 patients were included (mean age 65±10 y, 57% female). ODI improvement was observed in 91% of patients, with 77% reporting satisfaction scores ≥4. Baseline ODI (median 62, IQR 46-74) improved to a median of 10 (IQR 1-10) 2 years postoperatively. Baseline (OR 0.98, P=0.015) and postoperative ODI scores (OR 0.93, P<0.001), as well as the difference between them (OR 1.04, P< 0.001), were significantly associated with patient satisfaction. Improvement of ≥38 ODI points or a relative change of ≥66% was indicative for patient satisfaction, with higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). With a sensitivity of 85% and a specificity of 77%, a postoperative target ODI of ≤24 indicated patient satisfaction.

Conclusion: Lower baseline ODI and greater improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction. A relative improvement of ≥66% or achieving a postoperative ODI score of ≤24 were the most indicative thresholds for predicting patient satisfaction, proving more sensitivity and specificity than an absolute change of ≥38 points.