Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative education session

Spine J. 2019 May;19(5):840-845. doi: 10.1016/j.spinee.2018.11.010. Epub 2018 Nov 22.


Background context: Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving recovery patterns. Presurgical 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 postsurgical 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 postsurgery. 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 two (Cohort; education: no education) × 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<.05.

Results: Patients (n=103) who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=.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=.03), improvement in walking capacity (p=.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=.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.

Keywords: Multidisciplinary preoperative education; Patient expectations; Satisfaction; Spinal fusion surgery.

MeSH terms

  • Canada
  • Female
  • Humans
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Patient Education as Topic / methods*
  • Patient Reported Outcome Measures*
  • Patient Satisfaction / statistics & numerical data
  • Postoperative Complications / epidemiology
  • Postoperative Complications / psychology*
  • Preoperative Period
  • Spinal Fusion / adverse effects
  • Spinal Fusion / psychology*