Infusing Patient Perspective in Outcomes Reporting for Pediatric Orthopedics

In pediatric orthopedics, scans and X-rays have traditionally been the markers of success when it comes to evaluating outcomes. For example, orthopedic surgeon Sumeet Garg, MD, can see a patient might have a 70-degree curvature in their spine before surgery and a 20-degree curvature afterward.

“That tells you, you reduced the curve by this much. But it doesn't really tell you — are they happier? Are they satisfied with their appearance? Are they able to do athletics better or have less pain?” Dr. Garg explains.

To get the full picture of how to measure success, Dr. Garg and his team have started integrating patient-reported outcome (PRO) surveys into their clinical care. After receiving grant funding from the Tai Foundation in 2022, the team began sending out these surveys to better understand patients’ perception of their health. The questionnaire asks about activity levels, depression symptoms, functional questions about their affected body part and how pain is impacting their life.

“This is great because we will see a patient one month after spine surgery and then not again for a year if they are doing well,” Dr. Garg says. “We can send this survey at pre-surgery, three months and six months after surgery to get a better sense of the progress of their recovery, so we can understand: How quickly does someone recover after this surgery? We can also compare post-surgical results to see if patients have improved function and symptoms from before surgery.”

So far, the team has enrolled more than 16,000 patients and collected more than 43,000 surveys. Their early findings are starting to paint a clearer picture of outcomes through a patient perspective, but the team is only beginning to explore the countless avenues of findings from this new data pool.

Spine surgery patient satisfaction outcomes

Dr. Garg and his team are using these PROs to see how patients feel after spine surgery.

“Sometimes we’ll see kids where the X-rays look amazing and you did the perfect surgery, but then they’re having pain still or not feeling happy,” Dr. Garg says. “Or the X-ray might not look great after, but they are feeling great. This lets us get some of that data in an objective way.”

The team found that prior to spine surgery, 73% of patients reported they were somewhat unhappy or very unhappy if they had to spend the rest of their life with their back shape as it appeared before surgery.

Patient-reported outcome measures in an early onset scoliosis (EOS) program showed how this approach allows healthcare providers to easily access data to assess the differences in surgical and nonsurgical pathways. The data showed that surgical EOS patients scored higher in pain interference and depressive symptoms than nonsurgical EOS patients. But at the 6-month follow-up visit, the nonsurgical EOS patients scored higher in depressive symptoms.

“Seeing the trends in this data can help providers decide on the best method of treatment for their patients and families moving forward,” Dr. Garg says.

Dr. Garg is also interested in using this data to explore how someone’s background might impact their outcome after spine surgery, in hopes of achieving successful outcomes for everyone in the program.