Improving post-operative patient reported benefits and satisfaction following spinal fusion with a single pre-operative education session.

Publication date: Available online 22 November 2018

Source: The Spine Journal

Author(s): Donna Eastwood, Neil Manson, Erin Bigney, Mariah Darling, Eden Richardson, Richard Paixao, Tracy Underwood, Kate Ellis, Edward Abraham

Background Context

Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and post-surgical healing is an important factor in improving recovery patterns. Pre-surgical education can potentially help manage patient expectations.

Purpose

The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective was to determine if participation resulted in improvements in post-surgical pain, disability, and reductions in emergency room visits following surgery.

Study Design

A retrospective cohort study utilizing data from the Canadian Spine Outcomes and Research Network (CSORN) registry and hospital electronic medical records.

Patient Sample

Participants were patients receiving elective spinal fusion for 2-5 levels (N = 206).

Cohort 1 included patients who participated in preoperative multidisciplinary education (n= 103). Cohort 2 included patients who opted out of the educational session (n= 103).

Outcome Measures

Outcomes measured included the Oswestry Disability Index (ODI), NRS scales for back and leg pain (NRS-B/NRS-L), CSORN questions pertaining to patient satisfaction with surgery and whether or not the surgery met expectations. Electronic chart review quantified emergency room visits following surgery.

Methods

Spinal fusion patients are encouraged to attend a one time, two-hour education session 3-6 weeks prior to their surgery. The education session includes interactive discussions with nursing, physiotherapy and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care post-surgery. A one-way ANOVA was conducted for continuous variables of interest (age, number of levels operated on, ASA score and number of visits to the emergency room following surgery). Chi-squared analysis was conducted for categorical variables of interest (pathology, gender, patient satisfaction, and patient expectations). A 2 (Cohort; education: no education) x 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<0.05.

Results

Patients (n=103) who took part in the pre-surgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p = 0.014). Patients (n=103) who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p = 0.03), improvement in walking capacity (p = 0.03) and their expectation of back pain reduction (p = .001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p = 0.03), although this improvement did not reach a minimally clinically important difference. Number of visits to the emergency room in the 12 weeks following spine surgery was significantly lower (p = 0.04) for patients in the education cohort.

Conclusions

Reduced emergency room utilization, improved patient satisfaction, achievement of expected improvements and alleviation of back pain were documented with greater success following participation in a single 2-hour educational session prior to surgery. A single education session is a viable tool for improving patient outcomes due to its low administrative burden.

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