University of New South Wales, South West Sydney Clinical School, Orthopaedic Department, Liverpool Hospital, Liverpool, NSW, 2170, Australia.
Injury. 2009 Apr;40(4):377-84. doi: 10.1016/j.injury.2008.08.039. Epub 2008 Nov 29.
Patient satisfaction has only recently gained attention as an outcome measure in orthopaedics, where it has been reported for joint replacement surgery. Little has been published regarding predictors of patient satisfaction in orthopaedic trauma. This study aims to explore the predictors of patient satisfaction, and of surgeon satisfaction, after orthopaedic trauma.
Adult patients admitted to hospital with fractures after motor vehicle trauma were surveyed on admission, and at six months. Demographic, injury, socio-economic and compensation-related factors were measured. The two outcomes were satisfaction with progress of the injury, and satisfaction with recovery. The treating surgeons were also surveyed at six months to determine surgeon satisfaction with progress, and recovery (using the same questions), and the presence or absence of fracture union and any complications. Multivariate analysis was used to determine significant predictors of satisfaction for both groups, and satisfaction rates were compared between surgeons and patients.
Of 306 patients recruited, 232 (75.8%) returned completed questionnaires, but only 141 (46.1%) surgeons responded. Patients rated their satisfaction with progress and recovery as 74.6% and 44.4%, respectively, whereas surgeon-rated satisfaction with progress and recovery was significantly higher, at 88.0% and 66.7%, respectively (p<0.0001). Significant predictors of patient dissatisfaction were: blaming others for the injury, being female, and using a lawyer. Patient-rated satisfaction was not significantly associated with objective injury or treatment factors. The only significant predictor of surgeon dissatisfaction was fracture non-union.
Orthopaedic surgeons overestimated the progress of the injury and the level of recovery compared to patients' own ratings. Surgeons' ratings were influenced by objective, treatment-related factors, whereas patients' ratings were not. Measures of outcome commonly used by orthopaedic surgeons, such as fracture union, do not predict patient satisfaction.
患者满意度作为骨科的一种疗效衡量标准，直到最近才受到关注，关节置换手术的相关报道已经屡见不鲜。然而，在骨科创伤领域，患者满意度的预测因素却鲜有报道。本研究旨在探讨骨科创伤患者满意度和医生满意度的预测因素。
对因机动车事故导致骨折而住院的成年患者在入院时和 6 个月时进行问卷调查，调查内容包括人口统计学、损伤、社会经济和赔偿相关因素。两个结果是对损伤进展和恢复情况的满意度。治疗医生也在 6 个月时对进展和恢复情况（使用相同的问题）、骨折愈合情况以及任何并发症的存在或不存在进行满意度调查，并确定医生对进展和恢复的满意度。采用多变量分析确定两组满意度的显著预测因素，并比较医生和患者的满意度率。
在招募的 306 名患者中，有 232 名（75.8%）患者完成了问卷调查，但只有 141 名（46.1%）医生做出了回应。患者对损伤进展和恢复的满意度分别为 74.6%和 44.4%，而医生对损伤进展和恢复的满意度则明显更高，分别为 88.0%和 66.7%（p<0.0001）。患者不满意的显著预测因素包括：将损伤归咎于他人、女性和聘请律师。患者的满意度与客观损伤或治疗因素无显著相关性。唯一显著的医生不满意预测因素是骨折不愈合。
与患者自身的评价相比，骨科医生高估了损伤的进展和恢复程度。医生的评价受到客观、与治疗相关的因素的影响，而患者的评价则没有。骨科医生常用的疗效衡量标准，如骨折愈合，不能预测患者的满意度。
