Treffer: P65. Using patient reported outcomes to examine concordance of expectations between surgeon and patients undergoing surgery for spine metastases.

Metastatic epidural spinal cord compression (MESCC) is a complex disease that impairs functional independence and quality of life. Separation and stabilization surgery is often palliative, not curative, and thus decisions about surgery should prioritize patient goals and expectations. However, the alignment of expectations between patients and surgeons in this patient population has yet to be studied. This study evaluates the concordance in expectations between surgeon and patient pre-operatively and between patient pre-operative expectations versus postoperative outcome at 6 weeks. Patients and physicians at OHSU Hospital or Hillsboro Medical Center. Patients >18 years old with metastatic epidural spinal cord compression and no cognitive impairment. The primary outcome measure is the degree of concordance between patient reported outcomes among surgeons and patients. The secondary outcome is the degree of concordance in pre-operative expectations of the patient with post-operative self-reported outcomes. Pre-operatively patients and providers completed the validated SOSGOQ2.0 survey containing questions about emotional health, social function, pain levels, bowel/bladder function, activity level, and motor function. Patients completed one survey about their current state before surgery and a modified second survey on their outcomes after surgery. Patients then completed post-operative surveys at serial time points. Surgeon versus patient expectations survey responses and patient pre-operative expectations versus post-operative outcomes were compared using Wilcoxon Signed Rank Test (p <0.05). All statistics were calculated using Python. Ten patients and twenty-eight surgeons were included in the analysis to date. Provider versus patient pre-operative expectations showed significant discordance involving pain, bowel/bladder function, and activity level. Results were mixed in the social category. Answers were most concordant in the motor function category. Analysis of patient pre-operative expectations versus patient post-operative outcome showed relative concordance in most categories with only four questions meeting the threshold for significant discordance including depression, ability to concentrate, confidence to self-manage pain, and activity level. Motor function appeared to be the most concordant category for provider-patient and patient pre and post operatively. This may be secondary to motor function being the most objective clinical exam measure or the component that surgeons are most comfortable discussing. Pain was difficult to predict, suggesting perhaps a surgeon's limited understanding of the multifactorial nature of pain and pain management for patients with metastatic disease. Alternatively, further counseling or optimization may help to better align these expectations. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]