TITLE: Patients Perceive Perioperative Complications as More Severe and Having Greater Negative
Consequences than Surgeons
AUTHORS (LAST NAME, FIRST NAME): Cabalo, Adam2; Bess, Shay1; Lanning, Kara2; Akbarnia,
Behrooz A.4; Boachie-Adjei, Oheneba5; Burton, Douglas C.6; Gupta, Munish7; Hostin, Richard 9;
Shaffrey, Christopher I.8; Wood, Kirkham B.10; Kebaish, Khaled M.11; Cunningham, Matthew E.5; Hart,
Robert A.2; Study Group, International Spine 3
INSTITUTIONS (ALL): 1. Orthopaedics, Rocky Mountain Hospital for Children, Denver, CO, USA.
2. Orthopaedics, Oregon Health Sciences University, Portland, OR, USA.
3. ISSG, San Diego, CA, USA.
4. San Diego Center for Spinal Disorders, La Jolla, CA, USA.
5. Hospital for Special Surgery, New York, NY, USA.
6. University of Kansas Medical Center, Kansas City, KS, USA.
7. University of California - Davis , Sacramento, CA, USA.
8. University of Virginia, Charlottesville, VA, USA.
9. Baylor Scoliosis Center, Plano, TX, USA.
10. Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
11. Johns Hopkins University, Baltimore, MD, USA.
ABSTRACT BODY:
Summary (80 words max): Survey of patient and surgeon perceptions of different
perioperative complications associated with spinal deformity surgery demonstrated patients
perceive complications more severe and more negatively impacting satisfaction and quality
of life than surgeons. Dural tear and blood transfusion demonstrated the greatest
discrepancy between patient and surgeon perceptions. These results demonstrate a
potential need for improved patient education and surgeon communication, and will be used
to further develop an adverse event impact instrument.
Introduction: The clinical and medicolegal consequences of perioperative complications
following spinal deformity surgery negatively impact outcomes. Patient outcomes following
perioperative complications have been evaluated, but a complications disability measure
does not exist. We evaluated surgeon and patient perceptions of different complications to
help create an adverse event impact instrument.
Methods: Descriptions of 22 spine surgery complications were administered to 14 spine
surgeons and 15 adult spinal deformity patients. Participants assigned visual analog severity
based numerical value to each complication (0-10; 0 = not severe, 10 = worst possible).
Questions included perceived; 1) complication severity =SEVERITY, 2) complication impact
upon procedure satisfaction=SATISFACTION, and 3) complication impact on quality of
life=LIFE. Values were evaluated using ANOVA and student’s t-test.
Results: Mean SEVERITY difference between surgeons (5.2, range 1.1 ±1.9=blood
transfusion-10.0 ± 0.0=death) and patients (6.4, range 2.6 ± 2.6=UTI- 9.2 ± 2.3=stroke)
approached significance (p=0.068). Mean SATISFACTION was similar for surgeons (5.0;
range 0.7 ±1.0=blood transfusion-10.0 ± 0.0=death) and patients (5.9; range 2.1 ±
2.3=UTI- 9.0 ± 2.8=death; p=0.22). Mean LIFE was significantly lower for surgeons (4.8;
range 1.0 ±1.0=UTI, to 10.0 ± 0.0=death) than patients (6.3; range 1.8± 2.3=UTI, to 9.5
± 1.0=stroke; p<0.05). Patients perceived blood transfusion, deep vein thrombosis, dural
tear, heart attack, lung failure, pulmonary embolus, and stroke significantly worse on all
measures (SEVERITY, SATISFACTION, and LIFE) than surgeons (p<0.05). Patient and
surgeon scores for dural tear and blood transfusion demonstrated the greatest discrepancy
in all measures.
Conclusion: Perioperative complications may worsen patient outcomes and have
medicolegal consequences. We found significant variation between surgeon and patient
perceptions of spine surgery complications. Patients believed complications would have
more severe impact on satisfaction and quality of life. This discrepancy highlights potential
need for improved surgeon communication and patient education. Future research will
compare these results to patients incurring complications.