Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery

Leah E Henry; Ali Aneizi; Vidushan Nadarajah; Patrick Mj Sajak; Kali N Stevens; Min Zhan; Mohit N Gilotra; Jonathan D Packer; R Frank Henn 3rd

doi:10.1016/j.jcot.2020.06.027

Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery

J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S829-S836. doi: 10.1016/j.jcot.2020.06.027. Epub 2020 Jun 16.

Authors

Leah E Henry¹, Ali Aneizi¹, Vidushan Nadarajah^{1

2}, Patrick Mj Sajak¹, Kali N Stevens¹, Min Zhan³, Mohit N Gilotra¹, Jonathan D Packer¹, R Frank Henn 3rd¹

Affiliations

¹ Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
² Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
³ Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.

Abstract

Background: 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.

Methods: 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)).

Results: 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).

Conclusion: 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.

Keywords: Expectations; Extremity orthopaedic surgery; Patient-reported outcomes; Risk factor modification.