Leon Brandon, Ventimiglia Dominic J, Honig Evan L, Henry Leah E, Tran Andrew, McCurdy Michael A, Packer Jonathan D, Meredith Sean J, Leong Natalie L, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
J Orthop. 2025 Jan 17;67:140-147. doi: 10.1016/j.jor.2025.01.024. eCollection 2025 Sep.
Both preoperative expectations and postoperative met expectations can independently influence patient-reported outcomes (PROs), however, their combined effect on PROs is not well understood. This study aimed to determine the prognostic significance of categorizing non-arthroplasty knee surgery patients into clusters based on both preoperative expectations and postoperative met expectations.
638 patients who underwent non-arthroplasty knee surgery from June 2015 to May 2021 at a single academic institution were analyzed. Patients were grouped based on both preoperative expectations and two-year postoperative met expectations scores using cluster analysis. Four distinct expectations cluster groups were formed: high preoperative-high met expectations (HIGH-HIGH), low preoperative-high met expectations (LOW-HIGH), high preoperative-low met expectations (HIGH-LOW), and low preoperative-low met expectations (LOW-LOW). Socioeconomic data and PROs were compared based on cluster group, and logistic regression was performed to determine the likelihood of achieving a patient-perceived "completely better" status based on cluster group.
Patients with high met expectations, regardless of preoperative expectations, reported better two-year PROs compared to patients with low met expectations. Patients with high preoperative expectations achieved better outcomes only when those expectations were met postoperatively. Low preoperative expectations did not preclude patients from achieving good outcomes, as long as those expectations were met. The HIGH-HIGH group had increased odds of achieving completely better status compared to the LOW-HIGH group (OR = 1.68, p = .02), HIGH-LOW group (OR = 16.69, p < .001), and LOW-LOW group (OR = 5.17, p < .001). The HIGH-LOW group had decreased odds of achieving completely better status compared to the LOW-LOW group (OR = .31, p = .01).
Met expectations may be a stronger predictor of postoperative outcomes than preoperative expectations in non-arthroplasty knee surgery. This study highlights the importance of setting realistic preoperative expectations and focusing on achieving expectations postoperatively. These findings offer valuable insights for clinicians to manage patient expectations effectively based on individual characteristics and expected treatment outcomes.
术前期望和术后期望达成情况均可独立影响患者报告的结局（PROs），然而，它们对PROs的综合影响尚不清楚。本研究旨在确定根据术前期望和术后期望达成情况将非关节置换膝关节手术患者分为不同类别所具有的预后意义。
对2015年6月至2021年5月在一家学术机构接受非关节置换膝关节手术的638例患者进行分析。采用聚类分析，根据术前期望和术后两年的期望达成情况评分对患者进行分组。形成了四个不同的期望聚类组：高术前期望-高期望达成（高高）、低术前期望-高期望达成（低高）、高术前期望-低期望达成（高低）和低术前期望-低期望达成（低低）。根据聚类组比较社会经济数据和PROs，并进行逻辑回归分析以确定基于聚类组达到患者感知的“完全好转”状态的可能性。
无论术前期望如何，期望达成程度高的患者与期望达成程度低的患者相比，两年的PROs更好。术前期望高的患者只有在术后期望得到满足时才能取得更好的结果。只要期望得到满足，低术前期望并不妨碍患者取得良好的结果。与低高组（优势比[OR]=1.68，p=0.02）、高低组（OR=16.69，p<0.001）和低低组（OR=5.17，p<0.001）相比，高高组达到完全好转状态的几率增加。与低低组相比，高低组达到完全好转状态的几率降低（OR=0.31，p=0.01）。
在非关节置换膝关节手术中，期望达成情况可能比术前期望更能预测术后结局。本研究强调了设定现实的术前期望并专注于术后实现期望的重要性。这些发现为临床医生根据个体特征和预期治疗结果有效管理患者期望提供了有价值的见解。
