The Disaggregated Oswestry Disability Index: What is the Most Predictive Subsection for Patient Satisfaction After Lumbar Surgery?

Study Design: Retrospective review of cohort studies.

Objective: To analyze how different ODI subsections and their improvement affect patient satisfaction 2 years after elective lumbar surgery for degenerative lumbar spondylolisthesis (DLS).

Background: The Oswestry Disability Index (ODI) is crucial in evaluating outcomes of spinal disorders and provides valuable insights into a patient's preoperative status. There is limited information available on the individual characteristics of its subsections and their relation to postoperative patient satisfaction.

Methods: Pre- and 2-year postoperative ODI and patient satisfaction were assessed. The analysis included preoperative scores and improvements in each ODI subsection 2 years postoperatively. Satisfaction was rated on a scale of 1 to 5, with scores ≥4 deemed satisfactory. Univariate linear regression and ROC analysis established cutoffs for subsection improvement and postoperative target values to achieve postoperative satisfaction.

Results: 265 patients (60% female, 67±8 years) were included. ODI improvement was achieved in 91%, and postoperative patient satisfaction in 73%. Patients with lower postoperative subsection scores and greater differences between pre- and postoperative scores were more likely to be satisfied (all P<0.001). A postoperative subsection target score of ≤1 was associated with patient satisfaction. Change in degree of pain was the most predictive subsection for satisfaction, with an AUC of 0.84 (sensitivity 79%, specificity 86%). Walking (AUC 0.83, sensitivity 87%, specificity 65%), pain intensity (AUC 0.82, sensitivity 79%, specificity 79%), personal care (AUC 0.82, sensitivity 83%, specificity 68%), and standing (AUC 0.82, sensitivity 83%, specificity 83%) all had an AUC greater than 0.80. The postoperative subsection with the lowest predictability was sleeping (AUC 0.69).

Conclusion: Pain domains, walking, standing, and personal care were the subsections with the highest predictability for patient satisfaction. These findings on the correlation between different ODI subscales and patient satisfaction are valuable for improving preoperative education, addressing disability, and ensuring postoperative satisfaction.