Wednesday, July 10, 2013

Complications - patient's perspective or surgeon's perspective?

The assessment of complications after spine surgery: time for a paradigm shift?

We are gratified with the shift from 'objective' measures of the success of surgery (x-rays, ranges of motion, measures of strength) to patient derived outcomes based on comfort and function. This article sought to quantify the patient-rated impact/severity of complications of spine surgery and directly compare the incidences of surgeon-rated and patient-reported complications. While it does not directly involve outcomes of shoulder surgery, one can trust that similar considerations would apply.

This prospective study of 2,303 patients undergoing surgery for painful degenerative lumbar disorders at a major medical center. Patients completed questionnaires before and 3 months after surgery. Surgeons documented complications before discharge and at the first postoperative follow-up, 6 to 12 weeks after surgery. 615 out of 2,303 patients reported complications, with "bothersomeness" ratings of 1%, not at all; 22%, slightly; 26%, moderately; 34%, very; and 17%, extremely bothersome.  By contrast, surgeons documented complications in 19% of patients. There was a minimal overlap regarding the presence or absence of complications in any given patient.

In that the goal of orthopaedics is to improve the comfort and function of patients, it is important that we judge the effectiveness of our treatment in these terms as will as in terms of patient-perceived complications. 

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