The relation between expectations and outcomes in surgery for sciatica

OBJECTIVE: To describe the expectations that patients and their physicians have for outcomes after surgical treatment for sciatica and to examine the associations between expectations and outcomes. DESIGN:Prospective cohort study. SETTING/PATIENTS: We recruited 273 patients, from the offices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians in Maine, wh o had diskectomy for sciatica, MEASUREMENTS AND MAIN RESULTS: Patients' and physicians' expectations were measured before surgery. Satisfaction with care and changes in symptoms and functional status were measured 12 months after surgery, More patients who expected a shorter recovery time after surgery were "delighted," "pleased, " or "mostly satisfied" with their outcomes 12 months after surgery than pa tients who expected a longer recovery time (odds ratio [OR] 2.2; 95% confid ence interval [CI] 1.1, 4.4). Also, more patients who preferred surgery aft er learning that sciatica could get better without surgery had good symptom scores 12 months after surgery than patients who did not prefer surgery (O R 2.9; 95% CI 1.2, 7.0). When physicians predicted a "great deal of improve ment" after surgery, 39% of patients were not satisfied with their outcomes and 25% said their symptoms had not improved, CONCLUSIONS: More patients with favorable expectations about surgery had go od outcomes than patients with unfavorable expectations. Physicians' expect ations were overly optimistic. Patient expectations appear to be important predictors of outcomes, and eliciting them may help physicians identify pat ients more likely to benefit from diskectomy for sciatica.