Henry Leah E, Aneizi Ali, Nadarajah Vidushan, Sajak Patrick Mj, Stevens Kali N, Zhan Min, Gilotra Mohit N, Packer Jonathan D, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S829-S836. doi: 10.1016/j.jcot.2020.06.027. Epub 2020 Jun 16.
Preoperative patient expectations and met expectations are likely associated with the outcome of treatment. However, there is a lack of data regarding the preoperative expectations and early postoperative met expectations of patients undergoing extremity orthopaedic surgery. The purpose of this study was to identify the predictors of early postoperative met expectations in a cohort of patients undergoing extremity orthopaedic surgery and to assess the relationship between patient expectations and patient-reported outcome (PRO) measures. We hypothesized that patients with higher preoperative expectation scores and higher postoperative met expectation scores would have better early postoperative outcomes.
Four hundred thirty-five patients age seventeen and older who underwent extremity orthopaedic surgery at one institution were prospectively enrolled in this study. Each patient completed a preoperative questionnaire that included an assessment of demographics, pain, function, general health, treatment expectations, activity level, and Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive testing. Expectations were evaluated using the Expectations Domain of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire. Patients completed a follow-up questionnaire two weeks after surgery that also assessed MODEMS met expectations and satisfaction (Surgical Satisfaction Questionnaire (SSQ-8)).
The mean preoperative expectation score was 86.95 ± 16.59, and the mean postoperative met expectation score was 55.02 ± 27.63 (0-100 scale with 100 representing the highest level of expectations). Greater met expectations were significantly associated with white race (p = 0.025), college degree (p = 0.011), and higher income (p = 0.002). Greater met expectations were also significantly associated with greater postoperative physical function, social satisfaction, activity level, and subjective improvement, as well as lower pain interference, joint pain, body pain, fatigue, anxiety, and depression (p < 0.01 for each). Multivariable analysis results found that less postoperative joint pain and greater postoperative social satisfaction, improvement, and physical function were all significant independent predictors of greater met expectations at two weeks postoperative (p < 0.01 for each).
Greater preoperative expectations are associated with better activity and less pain two weeks after surgery. Met expectations of extremity orthopaedic surgery were associated with postoperative physical function, social satisfaction, activity, pain, anxiety, depression, and subjective improvement. These results may have implications for preoperative counseling and risk factor modification.
术前患者的期望以及期望达成情况可能与治疗结果相关。然而，关于接受四肢骨科手术患者的术前期望和术后早期期望达成情况的数据尚缺。本研究的目的是确定接受四肢骨科手术患者队列中术后早期期望达成的预测因素，并评估患者期望与患者报告结局（PRO）指标之间的关系。我们假设术前期望得分较高且术后期望达成得分较高的患者术后早期结局会更好。
前瞻性纳入了在一家机构接受四肢骨科手术的435例17岁及以上患者。每位患者完成一份术前问卷，内容包括人口统计学、疼痛、功能、总体健康状况、治疗期望、活动水平以及患者报告结局测量信息系统（PROMIS）计算机自适应测试。使用肌肉骨骼结局数据评估与管理系统（MODEMS）问卷的期望领域来评估期望。患者在术后两周完成一份随访问卷，该问卷也评估MODEMS期望达成情况和满意度（手术满意度问卷（SSQ-8））。
术前期望平均得分为86.95±16.59，术后期望达成平均得分为55.02±27.63（0至100分制，100分代表最高期望水平）。更高的期望达成与白人种族（p = 0.025）、大学学历（p = 0.011）和更高收入（p = 0.002）显著相关。更高的期望达成还与术后更好的身体功能、社会满意度、活动水平和主观改善显著相关，以及与更低的疼痛干扰、关节疼痛、身体疼痛、疲劳、焦虑和抑郁显著相关（每项p < 0.01）。多变量分析结果发现，术后关节疼痛较少以及术后社会满意度更高、改善程度更大和身体功能更好，均是术后两周期望达成更高的显著独立预测因素（每项p < 0.01）。
更高的术前期望与术后两周更好的活动能力和更少的疼痛相关。四肢骨科手术的期望达成与术后身体功能、社会满意度、活动、疼痛、焦虑、抑郁和主观改善有关。这些结果可能对术前咨询和风险因素调整有影响。
