Fusion versus Non-fusion Surgery for Pediatric Idiopathic Scoliosis: Preferences of Patients, Caregivers, and Patient-Caregiver Dyads

Study DesignOriginal research, cross-sectional study.ObjectivesEvaluate preferences of patients, caregivers, and patient-caregiver dyads for non-fusion vs fusion surgery.MethodsA survey-based discrete choice experiment included patients 12-15 years of age with idiopathic scoliosis and their caregivers. Preference weights were estimated for 2 types of attributes that differed between fusion and non-fusion surgery: treatment outcomes (ie, appearance, confidence in planned correction, spinal motion, device failure, reoperation, and recovery period) and procedure-type requirements associated with each surgery type. Correlations between preference weights for patients, caregivers, and dyads were calculated to assess preference concordance between cohorts.ResultsA total of 344 respondents (124 patients, 92 caregivers, and 128 patient/caregiver dyads) completed the survey. Appearance was the most important treatment outcome for the average respondent in all cohorts. For patients, the least important treatment outcome was recovery time, whereas reoperation rate was the least important treatment outcome for caregivers and dyads. After controlling for treatment outcomes, patients and patient-caregiver dyads preferred the procedure-type requirements associated with fusion surgery, while caregivers preferred the procedure-type requirements associated with non-fusion surgery. Preferences of respondents who completed the survey prior to surgery were similar to those who completed the survey after surgery. Patient and caregiver preferences were more similar to the preferences of dyads than to each other.ConclusionsPatients and patient-caregiver dyads preferred the procedure-type requirements associated with fusion surgery, while caregivers preferred the procedure-type requirements associated with non-fusion surgery. Appearance was the most important treatment outcome for patients, caregivers, and patient-caregiver dyads.