Hello, my name is Michael Schost, and today I'll be presenting on the effective approach on patient satisfaction following fusion for degenerative lumbar disease. I'd like to begin by thanking AANS for the opportunity to share work today, as well as my co-authors for their contributions on this project. We have no disclosures to report. The Hospital Consumer Assessment of Healthcare Provider and Systems, or HCAHPS survey, is a multi-item tool utilized by CMS to approximate patient satisfaction and experience in the hospital, and it's then used in part to determine reimbursement. And so we're interested in looking at different operations for degenerative lumbar disease, specifically those with either a posterior or anterior approach, as we know that these operations have very comparable long-term outcomes and are both very good operations. But we wanted to see specifically how they would compare in terms of the results that they received with this HCAHPS survey. Our study includes 173 patients who underwent lumbar spine surgery at the Cleveland Clinic between 2010 and 2020, and in order to try to make these groups as homogenous as possible for the anterior and posterior groups, we limited them to those with a degenerative etiology who underwent either a one- or two-level index fusion and had completed the HCAHPS survey. Our data collection included the HCAHPS survey, as well as the PROMIS Mental and Physical Health and the Visual Analog Score, or VAS, for back pain. And statistical analysis was completed using Pearson and students' t-test. And so here you can see our results. Table 1 on the left shows patient demographic data, and then at the bottom you can see the survey response time. So these HCAHPS surveys were sent out within six weeks of surgery, and then as you can see here, were returned approximately one month later. So this roughly corresponds to these capturing the patient satisfaction and experience at that three-month postoperative visit. And so the overall provider rating that was garnered from these HCAHPS surveys showed a 12% higher rating for the posterior fusion group compared to the anterior fusion group. Table 2 on the right shows that PROMIS scores had no significant difference between the posterior and anterior groups. However, VAS for back pain showed an improvement in back pain in the posterior group compared to the anterior at the three-month visit. However, there's no difference between the anterior and posterior groups at the six-month visit, and furthermore, both groups show significant improvement in back pain at six months. So in conclusion, in looking at our patient population who had comparable indications for spine surgery and ultimately had similar long-term outcomes following their surgery, our data still suggests that there exists a difference in satisfaction between those who had an anterior and posterior approach as measured by the HCAHPS surveys. And part of this disparity might be explained by the snapshot in time that was provided by the HCAHPS survey at roughly that three-month period versus the more longitudinal outcome measures that are favored by surgeons when evaluating the quality of an operation. And in future studies, we hope that we might identify practices to minimize pain in this early post-operative period as we understand that it's important for the patient experience and may result in overall better patient satisfaction. Thank you.

Michael Schost

patient satisfaction

fusion surgery

posterior approach

anterior approach