{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:50:13Z","timestamp":1760403013153,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T00:00:00Z","timestamp":1641686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Only limited qualitative research concerning instrumented spine surgeries has been published, despite the increasing number of these surgeries and the evident importance of qualitative analysis of the processes surrounding these complex interventions. Current qualitative research is mainly limited to the experiences, emotions and expectations of patients. Insight into the full process, including experiences from the perspective of informal caregivers and healthcare professionals, remains scarce. Materials and Methods: Data were gathered by means of semi-structured face-to-face interviews. In total, there were 27 participants, including 11 patients, 7 informal caregivers and 9 healthcare professionals. The interview process was audiotaped, and each interview was transcribed verbatim. To systematically analyse the gathered data, software for qualitative analysis (NVivo) was used. After immersion in the raw data of transcripts and field notes, a list of broad categories for organising the data into meaningful clusters for analysis was developed. All interviews were coded by the first author, and 25% was independently assessed by the second author. Results: The results of our study describe several promoting and limiting factors concerning the process of lumbar fusion surgery from the perspective of patients, informal caregivers and healthcare providers. The most frequently mentioned promoting factors were: information and opportunities to ask questions during consultations; multidisciplinary consultations; good communication and guidance during hospitalization; and follow-up appointments. The most frequently mentioned limiting factors were: lack of educational material; lack of guidance and communication prior to, during and after hospitalisation. Conclusion: Overall, participants were satisfied with the current healthcare-process in lumbar fusion surgery. However, we found that lack of educational material and guidance during the process led to insecurity about complaints, surgery and recovery. To improve the process of lumbar interbody fusion and to increase patient satisfaction, healthcare providers should focus on guiding and educating patients and informal caregivers about the pre-operative trajectory, the surgery and the recovery. From the healthcare providers\u2019 perspective, the process could be improved by multidisciplinary consultations and a dedicated spine team in the operation room. Although this study focusses on lumbar fusion surgery, results could be translated to other fields of spine surgery and surgery in general.<\/jats:p>","DOI":"10.3390\/medicina58010099","type":"journal-article","created":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T23:06:15Z","timestamp":1641769575000},"page":"99","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Process Evaluation of Lumbar Interbody Fusion Surgeries in Five Dutch Hospitals: A Qualitative Analysis"],"prefix":"10.3390","volume":"58","author":[{"given":"Ruud","family":"Droeghaag","sequence":"first","affiliation":[{"name":"CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurosurgery, Zuyderland Medical Centre, Sittard-Geleen, 6130 MB Heerlen, The Netherlands"},{"name":"Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, 6130 MB Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inge J. M. H.","family":"Caelers","sequence":"additional","affiliation":[{"name":"CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurosurgery, Zuyderland Medical Centre, Sittard-Geleen, 6130 MB Heerlen, The Netherlands"},{"name":"Department of Neurosurgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2086-6106","authenticated-orcid":false,"given":"Aggie T. G.","family":"Paulus","sequence":"additional","affiliation":[{"name":"CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Health Services Research, Maastricht University, 6200 MD Maastricht, The Netherlands"},{"name":"School of Health Professions Education, Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter L. W.","family":"van Hemert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, 6130 MB Heerlen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henk","family":"van Santbrink","sequence":"additional","affiliation":[{"name":"CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Neurosurgery, Zuyderland Medical Centre, Sittard-Geleen, 6130 MB Heerlen, The Netherlands"},{"name":"Department of Neurosurgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of The LIFT-Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,9]]},"reference":[{"key":"ref_1","unstructured":"United Nations (2017). World Population Ageing: Highlights, United Nations."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1177\/2192568218790557","article-title":"Utilization and Economic Impact of Posterolateral Fusion and Posterior\/Transforaminal Lumbar Interbody Fusion Surgeries in the United States","volume":"9","author":"Saifi","year":"2019","journal-title":"Global Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1097\/BRS.0000000000002534","article-title":"Lumbar interbody fusion: A historical overview and a future perspective","volume":"43","author":"Rijkers","year":"2018","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1136\/qhc.12.1.40","article-title":"Process evaluation on quality improvement interventions","volume":"12","author":"Hulscher","year":"2003","journal-title":"BMJ Qual. Saf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ijotn.2016.06.001","article-title":"Spinal fusion surgery: From relief to insecurity","volume":"24","author":"Damsgaard","year":"2017","journal-title":"Int. J. Orthop. Trauma Nurs."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100707","DOI":"10.1016\/j.ijotn.2019.07.003","article-title":"Between hope and fear: A qualitative study on perioperative experiences and coping of patients after lumbar fusion surgery","volume":"35","author":"Trompetter","year":"2019","journal-title":"Int. J. Orthop. Trauma Nurs."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S99","DOI":"10.1016\/j.spinee.2015.07.046","article-title":"Patients\u2019 experience and expectations of lumbar spine surgery for degenerative conditions: A qualitative study","volume":"15","author":"Archer","year":"2015","journal-title":"Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: Exploring its conceptualization and operationalization","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual. Quant."},{"key":"ref_10","unstructured":"Bazeley, P., and Jackson, K. (2013). Qualitative Data Analysis with NVivo, SAGE Publications Limited."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e003112","DOI":"10.1136\/bmjopen-2013-003112","article-title":"Patient-initiated questions: How can doctors encourage them and improve the consultation process? A qualitative study","volume":"3","author":"Murtagh","year":"2013","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S295","DOI":"10.4103\/2152-7806.139612","article-title":"Multidisciplinary in-hospital teams improve patient outcomes: A review","volume":"5","author":"Epstein","year":"2014","journal-title":"Surg. Neurol. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"744","DOI":"10.3171\/2016.11.SPINE16537","article-title":"A systematic multidisciplinary initiative for reducing the risk of complications in adult scoliosis surgery","volume":"26","author":"Sethi","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","first-page":"1","article-title":"Need for post-operative outpatient appointments after discharge following cervical spinal surgery-a narrative review","volume":"21","author":"Atsma","year":"2020","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1001\/archinternmed.2010.105","article-title":"Effect of hospital follow-up appointment on clinical event outcomes and mortality","volume":"170","author":"Grafft","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13741-019-0122-2","article-title":"Primer on adult patient satisfaction in perioperative settings","volume":"8","author":"Trinh","year":"2019","journal-title":"Perioper Med. (Lond.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s43390-020-00037-0","article-title":"Dedicated spine nurses and scrub technicians improve intraoperative efficiency of surgery for adolescent idiopathic scoliosis","volume":"8","author":"Murgai","year":"2020","journal-title":"Spine Deform."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Isautier, J.M., Copp, T., Ayre, J., Cvejic, E., Meyerowitz-Katz, G., Batcup, C., Bonner, C., Dodd, R., Nickel, B., and Pickles, K. (2020). Lessons from the COVID-19 pandemic: People\u2019s experiences and satisfaction with telehealth during the COVID-19 pandemic in Australia. medRxiv.","DOI":"10.1101\/2020.09.10.20192336"},{"key":"ref_19","unstructured":"Ricoeur, P. (1976). Interpretation Theory: Discourse and the Surplus of Meaning, TCU Press."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/99\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:14:42Z","timestamp":1760364882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/99"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,9]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["medicina58010099"],"URL":"https:\/\/doi.org\/10.3390\/medicina58010099","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,1,9]]}}}