P66. Disagreement between patients’ and surgeons’ expectations for outcomes of lumbar surgery according to domains of physical and mental health

BACKGROUND CONTEXT Agreement between patients and surgeons regarding expectations of lumbar surgery may vary depending on whether expectations are for improvement in physical or mental health.  Focusing patient-surgeon communication on health domains where there is more disagreement should be a priority before surgery. PURPOSE To compare agreement within the patient-surgeon pair for expected improvement in domains of physical and mental health, STUDY DESIGN/SETTING Cross-sectional, tertiary spine. PATIENT SAMPLE This study included 402 lumbar surgery patient-surgeon pairs. OUTCOME MEASURES HSS Lumbar Spine Surgery Expectations Survey. METHODS Patients of five spine surgeons were interviewed preop and completed the ODI and the valid 20-item Expectations Survey, which is composed of four domains: personal activities (eg, sit); complex function (eg, exercise, stop condition from getting worse); psychological well-being (eg emotional stress); and skeletal function (eg, balance). The survey asks how much improvement is expected for each item with response options of complete to no improvement, and a total score and four domain scores are generated (possible score range 0-100, higher is greater expectations). Surgeons completed an identical survey asking them to rate expected improvement for each item for each patient, yielding similar total and domain scores. Agreement within the patient-surgeon pair was measured with the intraclass correlation coefficient (ICC), range 0-1.0 (0-.20 poor; .21-.40 fair; .41-60 moderate; .61-.80 good; .81-1.0 excellent agreement). Differences between patients’ and surgeons’ scores were then assessed in multivariable models controlling for psychosocial and surgical characteristics. RESULTS Mean age was 55, 55% were men, 21% were non-white race/ethnicity, 79% had degenerative conditions, and mean ODI score was 53 (range 4-84). Patients and surgeons independently completed the survey within 10 days preop. Patients’ mean survey scores were greater than surgeons’ scores for each domain: personal activities 65 vs 50; complex function 84 vs 66; psychological well-being 74 vs 58; and skeletal function 69 vs 51 (p CONCLUSIONS Agreement between patients’ and surgeons’ expectations was poor-to-good with patients expecting greater improvement in all domains. Agreement was similar for physical and mental health expectations, but was markedly worse for complex functions. Greater disability was most consistently associated with less agreement for all domains, indicating that disability impacts perceptions of all aspects of health. Thus preop discussions should consider disability when addressing expectations for both physical and mental health. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.