Accurate Identification of Complications after Spine Surgery: Surgeon’s Records vs. Patient Reported Outcome Questionnaire

Purpose: Retrospective studies frequently utilize patient office notes to determine the incidence of adverse outcomes. To our knowledge no study has compared the relative accuracy of surgeon office notes to a patient reported outcome questionnaire in the identification of adverse outcomes after spine surgery. The purpose of this study is to compare these two sources of information and determine if office notes reliably reflect the patients’ outcome status.

Methods: Consecutive patients that underwent primary anterior cervical arthrodesis and follow-up during a 9-month study period by 1 of 2 fellowship trained spine surgeons in separate practices were included. At the time of office visits, the surgeons were unaware that their office notes were going to be used. At the end of the study period, office notes for 6wk, 3mo and 6mo postop visits were independently reviewed and patients were mailed a 6-question survey, which asked about the occurrence, time course and severity of postoperative dysphagia and dysphonia. The presence of such symptoms according to the office notes at each visit was compared to the questionnaire report for that same period. Statistical analysis using the Kappa coefficient for pair-wise agreement was performed with K>0.70 denoting good correlation.

Results: During the study period 132 patients had 302 postop visits. At the time of the 302 visits, dysphagia was reported 21 times in office notes and 89 times by survey (K=0.13). Dysphonia was reported 9 times in the medical record and 64 times by survey (K=0.09). Based on the survey data, dysphagia and dysphonia were underreported in the medical record 76% and 86% of the time respectively. Even symptoms regarded by patients as “severe” were underreported in 55% of cases (K=0.29). The frequency of underreporting was statistically similar for the two surgeons.

Discussion: A very poor correlation between office notes and patient survey was found for our chosen adverse outcomes. While we chose to study dysphonia and dysphagia, we believe that the results may be generalizable to many situations where office notes are utilized to ascertain the incidence of adverse outcomes. These results suggest that the true incidence of adverse outcomes may be seriously underreported in the surgeon’s office notes and that any retrospective study that relies upon such notes to determine patient outcomes should be viewed with skepticism.