Medical management of bone loss from a spinal surgeon’s perspective

Osteoporosis is a common metabolic disorder in which the mineral and structural properties of the bone are compromised as a result of multiple, often endocrine, factors. Osteoporosis and other bone loss disorders will impact all spine surgeons. With the aging of the population, surgeons caring for adults will no doubt treat patients sustaining spinal fragility fractures from the dens to the sacrum. Moreover, all spine surgeons, even pediatric deformity specialists, will encounter challenges in successful spinal fixation related to poor bone quality. To adequately care for these patients, the physician requires a reasonable familiarity with the disease state and its implications on the spine. The surgeon must be able to identify at-risk patients, assess their bone mineral density, and, increasingly, initiate treatment.     

Quality of information concerning cervical disc herniation on the Internet

Background ContextMany Americans seek and are influenced in their decision making by medical information on the Internet. Past studies have repeatedly found information on most medical Web sites to be deficient and of low quality. Physicians must remain aware of the quality and reliability of the information available on the Internet for patient education purposes.PurposeTo assess quality and authorship of Internet Web sites regarding a common cervical spine disorder, cervical disc herniation.Study DesignThe present study is a systematic quality assessment survey of Web sites concerning cervical disc herniation.MethodsFifty relevant and unique sites were identified. The five most popular search engines were used to identify 100 Web sites using the search term, “cervical disc herniation.” Using a validated technique, three orthopedic surgeons independently generated content quality scores and accuracy scores, then integrated into a single final total summary score for each Web site.ResultsFour of the five identified top-scoring Web sites were found to be commercial and one was academic. Most of the Web sites were found to be physician sponsored, followed by academic and commercial.ConclusionsThere is wide variability in Web site quality, with most of the Web sites failing to be sufficiently comprehensive and accurate. Physicians treating patients with cervical disc herniation must remain vigilant in guiding their patients to proper information on the Internet.     

How to measure the quality of surgery-related web sites

Appropriateness and adequacy of health information on the Internet varies. Given there is no validated instrument for web site evaluation focusing on elective general surgical procedures, our goal was to create a composite score as a web site quality rating system. The components of a composite score were developed through a literature review and included Agency for Healthcare Research and Quality guidelines of "Having Surgery? What You Need to Know" and previously published health-related web site scales. All criteria are given equal weight (0/1 scale). The composite score is reported as a percentage of a total possible 16 points. To pilot the rating scale, a web search for roux-en-y gastric bypass (RYGB) was used. Validation compared the composite score with an evaluation by surgeons. Mean composite score for 18 RYGB web sites was 48 per cent (range, 19% to 75%). Composite score validation used a cutoff value of 50 per cent. There was 100 per cent agreement (kappa = 1.0) between composite and surgeon scores. This is the first validated comprehensive composite score to evaluate the web site quality for patients undergoing elective surgery. This score shows promise in increasing efficiency of surgical practices by providing a way in which we can evaluate web sites and encourage our patients to become well informed by reading only high-quality web sites.     

The Patient Experience: An Analysis of Orthopedic Surgeon Quality on Physician-Rating Sites

Background

With the advent of the Consensus Core of Orthopedic Measures, arthroplasty surgeons are increasingly subjected to public performance reviews on physician-rating sites. Therefore, we evaluated (1) web site details of physician-rating sites, (2) differences between sites and the Consensus Core, (3) published patient experiences, (4) search rank among sites, and (5) differences between academic vs nonacademic and arthroplasty vs nonarthroplasty surgeons.

Revision surgery for adult spine deformity

Adult spinal deformity is a common problem that affects 60% of the population aged 65 and older and can be physically and mentally disabling. The primary focus of this chapter is to discuss the advances of revision spine surgery and the difficulties that spine surgeons encounter. Spine surgeries are demanding on the surgeon and on the patient with complication rates close to 40% and secondary spine surgeries becoming more prevalent. Complex medical patients also pose another inherent barrier to successful revision surgery. The following chapter outlines the process of revision surgery and current techniques.     

Patient education through the Internet: academic and private practice sites

Although Internet use among patients continues to increase, the quality of disseminated information in orthopaedic surgery often is substandard. We reviewed and compared the web sites of academic orthopaedic surgery departments and private practices and rated their informational content with respect to patient education. Only 11.5% of academic sites and 52% of private practice sites list information on common orthopaedic conditions. Of these, less than 1/3 have information on various topics, and few have links to other patient education sites. Private practice web sites make better use of the Internet to provide patients with practical information about their individual practices. Few sites post the date of last update and those that do often have not been updated for more than 6 months. Academic and private practices underutilize the Internet as an educational resource. Orthopaedic surgeons are missing an important opportunity to provide accurate and reliable information to their patients.     

Rancho Los Amigos Medical Center. A unique orthopaedic resource and teaching institution

Rancho Los Amigos Medical Center, initially a poor farm in the County of Los Angeles, CA became a world renown medical institution because of the polio epidemics in the 1950s. Responding to the need for day to day inpatient care were an overflow of victims of polio who had spine and extremity weakness and were dependent on respirators. Team care, developed at the institution, was used by Vernon L. Nickel, chief orthopaedic surgeon so that maximum use of the limited staff's efforts would be to take care of patients. This need spawned many innovative developments through clinical observations and trials, basic research, and engineering innovations that resulted in the patient's functional improvement and helped return many victims of polio to independence and to their communities. Subsequently, orthopaedic surgeons, Jacquelin Perry, and Alice Garrett joined the full-time staff as the workload increased. Stabilizing the spine using fascial supports, spinal fusion, spinal instrumentation, orthoses, and seating systems allowed those patients who were not totally dependent on respirators to be upright and mobilized. When polio was eradicated, newer programs were established for physically disabled persons with musculoskeletal disorders affecting the spine and extremities and for those patients with congenital, acquired, neurologic, and neuromuscular disorders. In formal graduate residency affiliations, fellowships, and continuing medical education programs orthopaedic surgeons from around the world have been taught the basic principles of "categorical care" for physically disabled people for 50 years. Orthopaedic care given through these programs formed the basis of a new orthopaedic subspecialty, Orthopaedic Rehabilitation.     

Patient knowledge regarding radiation exposure from spinal imaging

Background Context

Spine surgeons employ a high volume of imaging in the diagnosis and evaluation of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques.

Questionnaire study of neuromonitoring availability and usage for spine surgery

STUDY DESIGN: Questionnaire study presented to practicing spine surgeons. OBJECTIVE: To evaluate surgeon preference and availability of selected electrophysiologic neuromonitoring for different spine surgeries. SUMMARY OF BACKGROUND DATA: Maximizing the safety of spinal procedures and limiting potential iatrogenic neurologic injury has made intraoperative neuromonitoring an attractive option. METHODS: We distributed a questionnaire to 180 orthopedic spine surgeons and neurosurgeons at a clinically oriented spine meeting asking surgeon preference and availability of various types of intraoperative neuromonitoring modalities for different types of surgical procedures. Demographic data were also gathered. RESULTS: Somatosensory evoked potentials (SSEPs) were the most available neuromonitoring modality, followed by electromyographies and motor-evoked potentials. In both anterior and posterior cervical surgery, SSEPs were the most preferred modality. MEPs were frequently preferred in myelopathic cervical cases. Almost 70% preferred some neuromonitoring for anterior thoracic/thoracolumbar cases and 55% for posterior thoracic/thoracolumbar cases. Surgeon satisfaction was related to the number of available neuromonitoring modalities. No significant differences were found between orthopedist and neurosurgeon preferences. Fellowship-trained surgeons were more likely to use neuromonitoring for specific indications. CONCLUSIONS: SSEPs remains the most widely available and preferred type of neuromonitoring for spine surgeons. The type of case and neurologic status of patient (eg, presence of myelopathy) affects these choices. Surgeons were more satisfied with greater neuromonitoring availability, and were more likely to use neuromonitoring if they had a fellowship background.     

Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures,fusion surgery,and pseudoarthrosis

Background contextOsteoporosis and osteomalacia are significant risk factors for fracture and spine instrumentation failure. Low-energy fractures are becoming increasingly more common because of an increase in life expectancy and age of the population. Decreased bone density is an independent risk factor for instrumentation failure in spinal fusion operations.PurposeTo assess the awareness and practice patterns of spine surgeons regarding metabolic bone disorders and osteoporosis with emphasis on fracture care and arthrodesis.Study design/settingQuestionnaire study.Patient sampleSpine surgeons attending the “Disorders of the Spine” conference (January 2007, Whistler, British Columbia, Canada).Outcome measuresRespondent reported frequencies of diagnostics, screening, and treatment methods for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis.MethodsA ten-question survey was administered to orthopedic surgeons and neurosurgeons who treated spine fractures and degenerative spine conditions in their practice. The survey was given to those who were attending a continuing medical education spinal disorders conference. The survey asked about treatment patterns with respect to osteoporosis and osteomalacia workup and treatment for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis.ResultsOf the 133 surgeons to whom the questionnaire was distributed at this meeting, 114 questionnaires were returned that corresponds to a response rate of 86%. Twenty-one surveys were excluded because of incomplete biographical information, resulting in a total of 93 completed questionnaires that were available for analysis. When treating patients with low-energy spine fractures, 60% checked dual-energy X-ray absorptiometry (DEXA) and 39% checked metabolic laboratories (of those who did not order laboratories and DEXA about 63% refer for treatment). Before instrumented fusion, 44% of those queried checked DEXA and 12% checked metabolic laboratories (vitamin D, parathyroid hormone [PTH], and calcium [Ca]). Before noninstrumented fusion, 22% checked DEXA and 11% checked metabolic laboratories. Before addressing pseudoarthrosis, 19% checked DEXA and 20% checked metabolic laboratories.ConclusionsDespite of the large number of elderly patients undergoing spine care and the high incidence of osteoporosis and/or osteomalacia in this population, a large portion of the spine surgeons who responded to the survey reported that they do not perform routine osteoporosis/osteomalacia workups. Of those who do perform workups, some commented that it will change their surgical plan or preoperative treatment. It appears that there is a need for increased awareness among spine specialists regarding osteoporosis screening and treatment. Osteoporosis practice patterns may also be affected with newly evolving government quality reporting regulations.     

Comparison between patient and surgeon perception of degenerative spine disease outcomes—a prospective blinded database study

Background

Few have studied the correlation between patients’ and spine surgeons’ perception on outcomes, or compared these with patient-reported outcome scores. Outcomes studies are increasingly important in evaluating costs and benefits to patients and surgeons, and in developing metrics for payer evaluation and health care policy-making.

Objective

To compare patients’ and surgeons’ assessment of spine treatment outcome in a prospective blinded patient-driven spine surgery outcomes registry, and to correlate perceived outcomes ratings to validated outcomes scores.

Methods

Patients filled out surveys at baseline, 3 months and 6 months postoperatively, including Visual Analog Scale (VAS), and Neck Disability Index (NDI) or Oswestry Disability Index (ODI). Outcome was rated independently by patients and surgeons on a 7-point Likert-type scale.

Results

Two-hundred and sixty-five consecutive adult patients were surgical candidates. Of these, 154 (58.1 %) opted for surgery, with 69 (44.8 %) cervical and 85 (55.2 %) lumbar patients. One hundred and thirty-five (87.7 %) had both patient and surgeon postoperative ratings. Surgeons’ and patients’ ratings correlated strongly (Spearman rho?=?0.53, p?<?0.0001, 45.9 % identical, 88.2 % +/? 1 grade). The surgeon rated outcomes were better than patients in 29.8 % and worse in 21.15 %. Patient rating correlated better with the most recent NDI/ODI and pain scores than with incremental change from baseline. In multivariate analysis, age, location (cervical vs lumbar), pain ratings, and functional scores (NDI, ODI) did not have significant impact on the discrepancy between patient and surgeon ratings.

Conclusions

Patients’ and surgeons’ global outcome ratings for spinal disease correlate highly. Patients’ ratings correlate better with most recent functional scores, rather than incremental change from baseline.     

Delayed epidural hematoma after spinal surgery: a report of 4 cases

Symptomatic postoperative epidural hematoma is a rare and potentially devastating complication of spinal surgery. The overwhelming majority of reported cases have occurred in the immediate postoperative period. A recent publication defined the clinical entity of delayed postoperative epidural spinal hematoma as neurologic deterioration due to an epidural hematoma occurring at least 3 days after the index procedure. Only 2 such cases have been reported in the lumbar spine to date. Four cases of delayed postoperative spinal epidural hematoma were identified over a 6-year period among the spine surgeons at a single large academic institution. Each case involved the lumbar spine. The details of each patient's initial surgery, presentation, and hospital course were then gathered from a retrospective chart review. The 4 patients presented are unusual in their delayed symptomatic presentations of postoperative spinal epidural hematoma. Despite the longer time to onset, however, our patients exhibited many of the characteristics common to cases that presented in the acute postoperative period. The spine surgeon must remain vigilant for the possibility of postoperative spinal epidural hematoma in at-risk patients, even weeks after the original surgical procedure.     

Artificial intelligence for adult spinal deformity: current state and future directions

As we experience a technological revolution unlike any other time in history, spinal surgery as a discipline is poised to undergo a dramatic transformation. As enormous amounts of data become digitized and more readily available, medical professionals approach a critical juncture with respect to how advanced computational techniques may be incorporated into clinical practices. Within neurosurgery, spinal disorders in particular, represent a complex and heterogeneous disease entity that can vary dramatically in its clinical presentation and how it may impact patients’ lives. The spectrum of pathologies is extremely diverse, including many different etiologies such as trauma, oncology, spinal deformity, infection, inflammatory conditions, and degenerative disease among others. The decision to perform spine surgery, especially complex spine surgery, involves several nuances due to the interplay of biomechanical forces, bony composition, neurologic deficits, and the patient's desired goals. Adult spinal deformity as an example is one of the most complex, given its involvement of not only the spine, but rather the entirety of the skeleton in order to appreciate radiographic completeness. With the vast array of variables contributing to spinal disorders, treatment algorithms can vary significantly, and it is very difficult for surgeons to predict how patients will respond to surgery. As such, it will become imperative for spine surgeons to utilize the burgeoning availability of advanced computational tools to process unprecedented amounts of data and provide novel insights into spinal disease. These tools range from predictive models built using machine learning algorithms, to deep learning methods for imaging analysis, to natural language processing that can mine text from electronic medical records or transcribed patient visits – all to better treat the intricacies of spinal disorders. The adoption of such techniques will empower patients and propel spine surgeons into the era of personalized medicine, by allowing clinical plans to be tailored to address individual patients’ needs. This paper, which exists in the context of a larger body of literatutre, provides a comprehensive review of the current state and future of artificial intelligence and machine learning with a particular emphasis on Adult spinal deformity surgery.     

Knee or Spine Surgery First? A Survey of Treatment Order for Patients With Concurrent Degenerative Knee and Lumbar Spinal Disorders

BackgroundTotal knee arthroplasty (TKA) and lumbar spine surgery have been reported to affect the outcomes of each other. There is insufficient evidence to guide the choice of treatment order for patients with both disorders that are equally symptomatic.MethodsFive clinical scenarios of concurrent, advanced, degenerative knee and lumbar spinal disorders were designed to survey surgeons’ choices of treatment order and rationale. The spinal disorder was consistently degenerative lumbar spinal stenosis, but the knee conditions varied to include (1) osteoarthritis (OA) with varus deformity, (2) OA with valgus deformity, (3) rheumatoid arthritis with a severe flexion contracture, (4) OA without deformity, and (5) bilateral OA with windswept deformities. The survey was distributed to selected clinical members of the Knee Society and Scoliosis Research Society in North America. The surgeons’ choices were compared among the 5 scenarios, and their comments were analyzed using text-mining.ResultsResponses were received from 42 of 74 (57%) knee arthroplasty surgeons and 55 of 100 (55%) spine surgeons. The percentages of knee arthroplasty surgeons recommending “TKA first” differed significantly among scenarios: 29%, 79%, 55%, 7%, and 81% for scenarios 1 through 5, respectively (P < .001). A similar pattern was noted for the spine surgeons.ConclusionFor patients with concurrent degenerative knee and lumbar spinal disorders, the severity and type of knee deformity influenced the preference of treatment order in both specialties. Severe valgus deformity and windswept deformities of the knee would drive the decision toward “TKA first.”     

The impact of surgeon volume on patient outcome in spine surgery: a systematic review

Purpose

Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers and adoption of volume standards. With limited literature promoting the regionalization of spine surgeries, we undertook a systematic review to investigate the impact of surgeon volume on outcomes in patients undergoing spine surgery.

Methods

We performed a systematic review examining the association between surgeon volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior cervical discectomy and fusion (ACDF), anterior/posterior cervical fusion, laminectomy/decompression, anterior/posterior lumbar decompression with fusion, discectomy, and spinal deformity surgery (spine arthrodesis).

Results

Studies were variable in defining surgeon volume thresholds. Higher surgeon volume was associated with a significantly lower risk of postoperative complications, a lower length of stay (LOS), lower cost of hospital stay and a lower risk of readmissions and reoperations/revisions.

Conclusions

Findings suggest a trend towards better outcomes for higher volume surgeons; however, further study needs to be carried out to define objective volume thresholds for individual spine surgeries for surgeons to use as a marker of proficiency.

     

Does specialty matter? A survey on 176 Italian neurosurgeons and orthopedic spine surgeons confirms similar competency for common spinal conditions and supports multidisciplinary teams in comprehensive and complex spinal care

Background Context

Spine surgery is a multifaceted subspeciality requiring a breadth of knowledge and skill from different branches of medicine for the treatment of pathologies varying from degenerative to deformity, oncological, and trauma.

中国髋关节置换术中骨水泥使用状况调查

目的通过对关节外科医师的调查,了解中国国内髋关节置换术中骨水泥的使用现状。方法 2009年8月～10月间通过信函方式向中国大陆地区30个省、自治区和直辖市共1016名从事人工关节置换的医师发出调查问卷。问卷分6个部分：（1）医师个人信息;（2）置换数量;（3）使用骨水泥基本情况;（4）初次置换中第三代骨水泥技术的应用;（5）骨水泥安全性;（6）抗生素骨水泥使用。总计21个问题。2010年2月前寄回的问卷,除外无效回复,其余均纳入统计分析。结果规定时间内共收回726份问卷,其中632份为有效回复,有效回复率62%。94%的被调查医师从事关节外科,同时从事创伤和脊柱专业的占58%和49%。65%的医师年均髋关节置换量少于40例;35%的医师使用骨水泥型髋关节置换比例占40%以上;69%的医师使用进口骨水泥,但分别有31%和41%的医师不清楚所使用骨水泥品牌和粘度。骨水泥枪、股骨远端塞、股骨柄中置器、脉冲冲洗的使用率分别为91%、79%、62%、46%。骨水泥加压措施使用率均低于20%。8%的医师曾遭遇1次以上骨水泥型髋关节置换患者术中死亡。12%的医师在初次髋关节置换中常规使用抗生素骨水泥。结论骨水泥型髋关节置换依然在国内被广泛采用,但在骨水泥具体操作使用方面存在较大差异和不足。需要加强骨水泥及相关技术的规范和教育。     

Vascular surgery and the Internet: a poor source of patient-oriented information.

OBJECTIVE: Increasing numbers of patients use the Internet to obtain medical information. The Internet is easily accessible, but available information is under no guidelines or regulations. We sought to evaluate the type, quality, and focus of vascular disease information presented on the Internet and the role in patient education with simple search techniques. METHODS: The arbitrarily chosen search phrases "abdominal aortic aneurysm (AAA)," "carotid surgery (CEA)," "claudication surgery," and "leg gangrene surgery" were entered into five common Internet search engines. No attempt was made to refine searches. As indicated by the search engines, the 50 most commonly encountered web sites for both AAA and CEA were reviewed. The first 25 claudication sites and the first 25 gangrene sites were combined for a total of 50 leg ischemia (LIS) sites. An information score (IS) was developed as a weighted score ranging from 0 (poor) to 100 (outstanding) and was designed to assess how well the web page educated the patient about the disease, the treatment options, and the medical and surgical complications. Each vascular surgery web site was classified according to the author, the referenced information source, and the therapeutic recommendations. This was followed by an evaluation of each web site with the IS independently scored by two observers. RESULTS: Of the 150 web sites, 146 were accessible. Ninety-six sites (65.8%) had no useful patient-oriented information (IS < 10). The mean IS and the ranges were: AAA, 14.9 (0 to 72.0); CEA, 17.5 (0 to 77.0); and LIS, 12.2 (0 to 44.5; P =.9). The mean IS of the 59 sites with scores of more than 10 were: AAA, 39.8 (n = 17); CEA, 44.8 (n = 19); and LIS, 24.8 (n = 23; P <.01, as compared with LIS scores). Differences in IS between observers were not significant (P =.9). Misleading or unconventional care recommendations were recognized in one AAA site (1 of 47, 2.1%), two CEA sites (2 of 49, 4.1%), and 13 LIS sites (13 of 50, 26.0%). The Joint Vascular Societies web page was identified only as a tertiary link. CONCLUSION: Patient-oriented vascular surgery information, for common vascular diseases, is difficult to find on the Internet. The overall quality is poor, and information is difficult to obtain in part because of the large number of irrelevant sites. Of the sites that were relevant to patient education (33%), one third presented information that was classified by the authors as misleading or unconventional. This was most apparent in the leg ischemia sites. The Internet is a poor overall source of patient-oriented vascular surgery information and education. Focused and refined searches and improvements in search engines and educational web sites may yield improved information. Public and medical community awareness needs to be improved regarding the severe limitations of the Internet as an information resource.     

Would you do it again? Discrepancies between patient and surgeon perceptions following adult spine deformity surgery

BACKGROUNDAdult spinal deformity (ASD) surgery can improve patient pain and physical function but is associated with high complication rates and long postoperative recovery. Accordingly, if given a choice, patients may indicate they would not undergo ASD surgery again.PURPOSEEvaluate surgically treated ASD patients to assess if given the option (1) would surgically treated ASD patients choose to undergo the same ASD surgery again, (2) would the treating surgeon perform the same ASD surgery again and if not why, (3) evaluate for consensus and/or discrepancies between patient and surgeon opinions for willingness to perform/receive the same surgery, and (4) evaluate for associations with willingness to undergo or not undergo the same surgery again and patient demographics, patient reported outcomes, and postoperative complications.STUDY DESIGNRetrospective review of a prospective ASD study.PATIENT SAMPLESurgically treated ASD patients enrolled into a multicenter prospective study.OUTCOME MEASURESScoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36) physical component summary (PCS) and mental component summary (MCS), Oswestry Disability Index (ODI), numeric pain rating for back pain (NRS back) and leg pain (NRS leg), minimal clinically important difference (MCID) for SRS-22r domains and ODI, intraoperative and postoperative complications, surgeon and patient satisfaction with surgery.METHODSSurgically treated ASD patients prospectively enrolled into a multicenter study were asked at minimum 2-year postoperative, if, based upon their hospital and surgical experiences and surgical recovery experiences, would the patient undergo the same surgery again. Treating surgeons were then matched to their corresponding patients, blinded to the patients’ preoperative and postoperative patient reported outcome measures, and interviewed and asked if (1) the surgeon believed that the corresponding patient would undergo the surgery again, (2) if the surgeon believed the corresponding patient was improved by the surgery and (3) if the surgeon would perform the same surgery on the corresponding patient again, and if not why. ASD patients were divided into those indicating they would (YES), would not (NO) or were unsure (UNSURE) if they would have same surgery again. Agreement between patient and surgeon willingness to receive/perform the same surgery was assessed and correlations between patient willingness for same surgery, postoperative complications, spine deformity correction, patient reported outcomes (PROs).RESULTSA total of 580 of 961 ASD patients eligible for study were evaluated. YES (n=472) had similar surgical procedures performed, similar duration of hospital and ICU stay, similar spine deformity correction and similar postoperative spinal alignment as NO (n=29; p>.05). UNSURE (n=79) had greater preoperative depression and opioid use rates, UNSURE and NO had more postoperative complications requiring surgery, and UNSURE and NO had fewer percentages of patients reaching postoperative MCID for SRS-22r domains and MCID for ODI than YES (p<.05). Comparison of patient willingness to receive the same surgery versus surgeon perceptions on patient's willingness to receive the same surgery demonstrated surgeons accurately identified YES (91.1%) but poorly identified NO (13.8%; p<.05).CONCLUSIONSIf given a choice, 18.6% of surgically treated ASD patients indicated they were unsure or would not undergo the surgery again. ASD patients indicating they were unsure or would not undergo ASD surgery again had greater preoperative depression, greater preoperative opioid use, worse postoperative PROs, fewer patients reaching MCID, more complications requiring surgery, and greater postoperative opioid use. Additionally, patients that indicated they would not have the same surgery again were poorly identified by their treating surgeons compared to patients indicating they would be willing to receive the same surgery again. More research is needed to understand patient expectations and improve patient experiences following ASD surgery.