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Doctors Overly Optimistic About Back Surgery

Careful Patient Selection Needed, Says Surgeon
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WebMD Health News

June 15, 2005 -- Surgeons tend to be "overly optimistic" when they counsel patients about the benefits of back surgery, a new study shows.

Almost 40% of patients in the study reported virtually no difference in back painback pain one year after having back surgery. But prior to surgery almost all of their surgeons predicted that they would have less pain and most said surgery would result in "a great deal of improvement."

The research is published in the June 15 issue of the journal Spine.

"Surgeons tended to give overly optimistic predictions, which were not correlated with patient outcome at one-year follow-up," wrote researcher Bertrand Graz, MD, and colleagues from Switzerland's University of Lausanne Medical Centre.

Back Surgery Failed to Help Many

A total of 197 patients who had surgery for low-back pain or sciaticasciatica were included in the study. Prior to operating, their surgeons were asked to predict how much the surgery would improve their patients' quality of life. The surgeons predicted that 79% of patients would have "a great deal of improvement" and 20% would have "moderate improvement."

A year after back surgery, the patients were questioned about their experience. More than half (56%) of those whose surgeons predicted a great deal of benefit reported no significant improvement in their general health.

Overall, the surgeons had predicted that 99% of patients would have some improvement with surgery. But a year later, 39% of the patients said the surgery did not help their back pain.

Ironically, the doctors were best able to predict surgical results for patients who were the poorest candidates for back surgery. Among the patients for whom surgery was considered inappropriate, based on strict guidelines, higher surgeon expectation was linked to greater improvement.

Psychosocial Factors Important

The study is not the first to find that surgery is not the cure-all for low-back pain that many patients think it is, or the first to suggest that doctors do a poor job of predicting which patients will benefit the most from back surgery.

Research presented last winter at the annual meeting of the American Academy of Orthopaedic Surgeons found that factors such as patient education level, depression, smoking, and whether or not a patient had filed a workers' compensation claim all affected surgical results among low-back-pain patients.

A researcher of that study, William Abdu, MD, tells WebMD that surgeons need to be aware that a host of physical, psychological, and social issues unrelated to back pain can influence surgical results.

"There is a tendency among patients to think that if they have an operation everything will be normal," he says. "But the more medical and psychosocial [issues] a patient has, the lower the expectations for surgery should be."

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