Boye Gloria N, Wylie James D, Miller Patricia E, Kim Young-Jo, Millis Michael B
Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
J Hip Preserv Surg. 2018 Nov 27;5(4):378-385. doi: 10.1093/jhps/hny041. eCollection 2018 Dec.
Our objective was to determine the frequency and strength of agreement between patients and their surgeons on preoperative expectations of the outcomes of periacetabular osteotomy (PAO) surgery. We also sought to determine whether patient preoperative function and pain levels were associated with patients' and surgeons' expectations and to identify the motivating factors for patients to undergo PAO. Two surgeons and their combined 68 patients preoperatively completed 4-point Likert-scales rating their expectations of improvement in six domains representing different hip symptoms after surgery. Domains included pain, stiffness, locking, stability, walking ability and athletic ability. Concordance between patient and surgeon expectation was evaluated by the percent of exact and partial agreement. Correlation analyses were performed to investigate associations between expectations of improvement and patient factors. Exact agreement between patients and surgeons ranged from 18.2% (stiffness) to 55.9% (pain) and partial agreement between patients and surgeons ranged from 48.5% (stiffness) to 100% (pain). Patients with higher UCLA scores tended to have lower surgeon expectations of improving walking ability ( = -0.34; = 0.007) but higher expectations for improved athletic ability ( = 0.25; = 0.04), and surgeons anticipated more improvement in walking for patients with higher stiffness ( = 0.31, = 0.01) and pain ( = 0.38, = 0.002). Similarly, patients with higher Short Form-12 physical component summary had lower surgeon expectations of improvement in walking ability ( = -0.40, = 0.002) and stiffness ( = -0.35, = 0.006). In the most domains there was frequent discrepancy between patient and surgeon expectations, with patients being more optimistic than their surgeons in every domain. For the pain domain, patients and surgeons had similar expectations.
我们的目标是确定患者与其外科医生在髋臼周围截骨术（PAO）手术结果的术前期望方面的一致频率和强度。我们还试图确定患者术前功能和疼痛水平是否与患者及外科医生的期望相关，并确定患者接受PAO手术的动机因素。两名外科医生及其共68名患者术前完成了4级李克特量表，对他们对代表术后不同髋部症状的六个领域改善情况的期望进行评分。这些领域包括疼痛、僵硬、卡顿、稳定性、行走能力和运动能力。通过完全一致和部分一致的百分比来评估患者与外科医生期望之间的一致性。进行相关性分析以研究改善期望与患者因素之间的关联。患者与外科医生之间的完全一致率从18.2%（僵硬）到55.9%（疼痛）不等，部分一致率从48.5%（僵硬）到100%（疼痛）不等。加州大学洛杉矶分校（UCLA）评分较高的患者，外科医生对其行走能力改善的期望往往较低（r = -0.34；P = 0.007），但对运动能力改善的期望较高（r = 0.25；P = 0.04），并且外科医生预计僵硬程度较高（r = 0.31，P = 0.01）和疼痛程度较高（r = 0.38，P = 0.002）的患者行走能力改善更多。同样，简短健康调查问卷12项身体成分汇总得分较高的患者，外科医生对其行走能力（r = -0.40，P = 0.002）和僵硬程度（r = -0.35，P = 0.006）改善的期望较低。在大多数领域，患者与外科医生的期望经常存在差异，在每个领域患者都比外科医生更乐观。对于疼痛领域，患者和外科医生的期望相似。
