Editorial Commentary: Assessing Outcomes in Terms of Fulfillment of Patient Expectations Is Complementary to Traditional Measures Including Satisfaction.

The topic of patients' expectations is receiving increasing attention as a patient-centered variable in preoperative orthopaedic assessment. Formally querying patients about expectations is necessary because surgeons may not be aware of these expectations, which often derive from multiple sources outside encounters with surgeons. Validated patient-derived surveys now exist for diverse orthopaedic surgeries to preoperatively measure expectations for improvement in symptoms and physical and psychological well-being. Assessing results of surgery in terms of fulfillment of these expectations is a patient-centered outcome that complements traditional measurements of satisfaction and pre- to postoperative change in symptoms and function. Validated follow-up surveys also now exist that ask patients for each item they expected before surgery, how much improvement have they actually received after surgery. The amount of improvement expected versus the amount of improvement received constitutes a measure of fulfilled expectations. The advantages of fulfillment of expectations as an outcome are that it prospectively includes both pre- and postoperative patients' perspectives and, because it is composed of multiple items, it can identify which symptoms and functions have improved to expected levels and which have not, thus providing the rationale for why patients rate outcomes the way they do. Therefore, measured in this way, postoperative fulfillment of expectations is a unique and novel patient-centered assessment for the comprehensive evaluation of orthopaedic surgical outcomes.