Determining the information needs of patients undergoing lumbar fusion.

Purpose

There is emerging evidence to support pre-operative education for patients undergoing elective spinal surgery. However, there is currently limited evidence and agreement regarding the actual content of the information given to patients before lumbar fusion surgery.

Anecdotally, patients at Guy´s and St Thomas´ NHS trust have expressed dissatisfaction with a lack of clear and concise preoperative information regarding their surgery, expected prognosis and rehabilitation milestones.

In contrast, patients awaiting hip and knee surgery have spoken positively about the experience of attending specifically tailored pre-surgical hip and knee classes.

At present, we are unaware of what information patients would find most useful before undergoing fusion surgery.

The primary aim of this study was to determine the information needs of lumbar fusion patients in order to inform the content and delivery of a pre-operative spinal education (POSE).

A follow up study will assess the impact of a tailored class on length of hospital stay (LOHS)

21 patients who attended Pre Operative Spinal Education (POSE)
prior to spinal fusion surgery reveal a reduction of two days Hospital Length of Stay

Approach

  • A focus group was conducted with post-operative fusion patients (n=3).
  • Semi-structured interviews with pre-operative lumbar fusion patients were undertaken (n=10).
  • Input was sought from all spinal surgeons, Physician Assistant (PA) and preoperative assessment team via email.
  • The opinions of the multi-disciplinary team were obtained from meetings with ward physiotherapists, nurses and occupational therapists.
  • Thematic analysis of qualitative data was used.
  • Comparison of current average length of stay data obtained from hospital records to data of patients attending POSE.

Outcomes

  • All stakeholders unanimously identified the need for pre-operative spinal education.
  • Patients expressed information needs related to post-operative fatigue, expectations of recovery, length of recovery time and medication requirements. All patients reported they would value an education session pre-operatively and identified the ideal time for delivery of this education session to be 1-2 weeks pre-operatively.
  • Ward clinicians stated a desire to empower patients to be proactive in their rehabilitation and planned discharge.
  • Consultants were keen for patients to understand the need and importance of early mobilisation post-operatively. Consultants wanted patients to have clear information regarding post-operative pain and the expected substantial length of post-operative recovery.
  • Physician assistants reported that patients most frequently asked questions related to recovery of physical function and the effect of smoking on wound healing.

 

Lumbar fusion patients expressed a desire for more detailed information than was previously provided to them. In particular, they wanted information related to the post-operative recovery process and expectations regarding pain and function.

Other stakeholders felt similarly that such information would reduce patient anxiety post operatively and assist patients in their recovery and rehabilitation.

Initial data on 21 patients who attended POSE prior to spinal fusion surgery reveal a reduction of two days HLOS compared to previous data.

Implications

We have established a fortnightly pre-operative spinal education class (POSE) and bespoke information for patients awaiting lumbar fusion surgery at GSTT. Reduction of HLOS represents a significant cost saving to the NHS and is the subject of further investigation

Fund acknowledgements

This work is unfunded. 

Additional notes

This work was presented at Physiotherapy UK 2019