Trajectories and Asymmetries in Patient and Surgeon Decisional Regret in Adult Spinal Deformity Surgery

BACKGROUND AND OBJECTIVES: Decisional regret (DR) measures perception of an event relative to one's own expectations, for example, the choice to undergo or perform adult spinal deformity (ASD) surgery. It is unclear how patient and surgeon DR evolves after ASD surgery and what drives asymmetry. METHODS: Nine hundred and twelve patients who underwent ASD surgery and their surgeons were asked at 6 weeks, 1 year, and 2 years postoperatively: “Would you have/perform the same surgery again?” (patient/surgeon SS). Responses were on a Likert scale (5 = Definitely yes, 4 = Probably yes, 3 = Unsure, 2 = Probably no, 1 = Definitely no). Patient-surgeon disagreement (D) was quantified as D = patient SS–surgeon SS; distributional symmetry was tested using the Wilcoxon signed-rank test. Multivariable ordinal regression evaluated factors associated with SS and disagreement. RESULTS: At 6 weeks, DR was low for both patients and surgeons. Over 2 years, patient same-surgery (SS) scores improved (odds ratios [OR] = 1.35-1.51, P = .02), whereas surgeon SS score remained stable ( P > .1). Patient-surgeon disagreement was small (<0.5 Likert points) but favored greater patient regret at 6 weeks (D = −0.26, P < .001) and 1 year (D = −0.19, P = .002), resolving by 2 years ( P = .09). Baseline disability was associated with greater early surgeon regret relative to patients (OR = 0.43–0.53, P < .02), whereas baseline opioid use was associated with greater long-term patient regret (OR = 1.77, P = .04). After revision surgery, patients were more likely to report improved SS score (39.7% vs 18.5%, P < .001), whereas surgeons were more likely to report worsening SS score (17.2% vs 11.1%, P = .003). Early patient SS score was associated with 2-year ODI (r = −0.241, P < .001) and Scoliosis Research Society-22 total score (r = 0.339, P < .001) and outperformed Scoliosis Research Society-22 satisfaction in predicting long-term outcomes ( P < .05). CONCLUSION: Patients and surgeons have low DR after ASD surgery, and when there is asymmetry, it is small and within the 1-year postoperative period. After revision, patients are more likely to have decreased regret, whereas surgeon regret does not improve. These findings have implications for patient counseling and expectations.