Rogers Miranda J, Agwuncha Chinelo C, Kazmers Nikolas H
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, Tenn.
Plast Reconstr Surg Glob Open. 2022 Mar 7;10(3):e4174. doi: 10.1097/GOX.0000000000004174. eCollection 2022 Mar.
Patient expectations before cubital tunnel release (CuTR), a common procedure that leads to incomplete symptom resolution for many patients, are unclear. Study purposes included (1) describing preoperative patient expectations, and (2) identifying factors affecting expectations.
Included patients underwent isolated unilateral CuTR between 2015 and 2021 at a single tertiary academic medical center. Expectations regarding the level of symptomatic improvement were queried preoperatively. Univariate and multivariable binary logistic regression was performed to determine factors associated with expecting great improvement.
Of the 92 included patients, 43 (47%) patients expected great improvement, whereas 27 (29%), four (4%), and five patients (5%) expected some, little, and no improvement, respectively. The remainder (14%) had no expectations. Multivariable modeling demonstrated that retired or unemployed/disabled work status, and commercial insurance status (versus Medicare or Medicaid) were associated with lower expectations independent of the surgeon, surgical technique, revision versus primary CuTR, preoperative atrophy or constant numbness, diabetes, and all studied demographic factors, including social deprivation.
Roughly half of the patients expect great relief, and a third expect lesser degrees of relief, following CuTR. Preoperative expectations are significantly higher in patients with Medicaid and Medicare insurance, representing an opportunity for education, given the association between public insurance payer status and worse health outcomes in general. Age, BMI, preoperative atrophy and/or numbness, and the presence of medical comorbidities do not influence expectations but have been shown to yield worse outcomes or influence need for revision CuTR, representing an opportunity for intervention to align patient and surgeon expectations.
尺神经沟松解术（CuTR）是一种常见手术，但许多患者术后症状并未完全缓解，术前患者的期望尚不明确。研究目的包括：（1）描述术前患者的期望；（2）确定影响期望的因素。
纳入2015年至2021年在一家三级学术医疗中心接受孤立性单侧CuTR手术的患者。术前询问患者对症状改善程度的期望。进行单因素和多因素二元逻辑回归分析，以确定与期望显著改善相关的因素。
92例纳入患者中，43例（47%）期望症状显著改善，而27例（29%）、4例（4%）和5例（5%）分别期望症状有所改善、改善不大或无改善。其余患者（14%）无期望。多因素模型显示，退休或失业/残疾工作状态以及商业保险状态（相对于医疗保险或医疗补助）与较低期望相关，且独立于外科医生、手术技术、翻修手术与初次CuTR手术、术前萎缩或持续麻木、糖尿病以及所有研究的人口统计学因素，包括社会剥夺情况。
大约一半的患者期望CuTR术后症状能大幅缓解，三分之一的患者期望缓解程度较小。医疗保险和医疗补助保险患者的术前期望显著更高，鉴于公共保险支付者状态与总体较差健康结局之间的关联，这代表了一个教育机会。年龄、体重指数、术前萎缩和/或麻木以及合并症的存在并不影响期望，但已显示会导致更差的结局或影响CuTR翻修手术的需求，这代表了一个调整患者和外科医生期望的干预机会。
