How Much Improvement in Oswestry Disability Index is Necessary to Make Your Patient Satisfied After Lumbar Surgery?

Abstract

Study design: Retrospective review of cohort studies.

Objective: To clarify the necessary Oswestry Disability Index (ODI) improvement for patient satisfaction 2 years after lumbar surgery.

Background: Evaluating elective lumbar surgery care often involves patient-reported outcomes. While postoperative functional improvement measured by ODI is theoretically linked to satisfaction, conflicting evidence exists regarding this association.

Material and methods: Baseline ODI and 2-year postoperative ODI were assessed. Patient satisfaction, measured on a scale from 1 to 5, with scores ≥4 considered satisfactory, was evaluated. Patients with incomplete follow-up were excluded. Statistical analyses included Mann-Whitney U and multivariable logistic regression adjusted for age, sex, and body mass index. Receiver operating characteristic analysis determined threshold values for ODI improvement and postoperative target ODI indicative of patient satisfaction.

Results: A total of 383 patients were included (mean age: 65 ± 10 y, 57% females). ODI improvement was observed in 91% of patients, with 77% reporting satisfaction scores ≥4. Baseline ODI (median: 62, interquartile range: 46-74) improved to a median of 10 (interquartile range: 1-10) 2 years postoperatively. Baseline [odds ratio (OR): 0.98, P = 0.015] and postoperative ODI scores (OR: 0.93, P < 0.001), as well as the difference between them (OR: 1.04, P < 0.001), were significantly associated with patient satisfaction. Improvement of ≥38 ODI points or a relative change of ≥66% was indicative of patient satisfaction, with higher sensitivity (80%) and specificity (82%) for the relative change versus the absolute change (69%, 68%). With a sensitivity of 85% and a specificity of 77%, a postoperative target ODI of ≤24 indicated patient satisfaction.

Conclusion: Lower baseline ODI and greater improvements in postoperative ODI are associated with an increased likelihood of patient satisfaction. A relative improvement of ≥66% or achieving a postoperative ODI score of ≤24 were the most indicative thresholds for predicting patient satisfaction, proving more sensitivity and specificity than an absolute change of ≥38 points.