J Hand Microsurg 2023; 15(04): 299-307
DOI: 10.1055/s-0042-1748782
Original Article

Preoperative Expectations in Hand Surgery Patients

Patrick M. J. Sajak
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Samir Kaveeshwar
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Ali Aneizi
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Alexander Hahn
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Cameran I. Burt
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Dominic J. Ventimiglia
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
2   Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, United States
,
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Raymond A. Pensy
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
R. Frank Henn III
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States
› Author Affiliations
Funding This work was supported by a grant from the James Lawrence Kernan Hospital Endowment Fund, Incorporated.

Abstract

Introduction Studies have shown a link between patients' preoperative expectations and their postoperative satisfaction. However, limited studies exist concerning patient factors associated with higher preoperative expectations in the hand surgery population. This study analyzed preoperative expectation scores of patients undergoing hand surgery and aimed to determine associated patient characteristics.

Materials and Methods A total of 418 elective hand surgery patients aged 15 years and older enrolled in a prospectively collected orthopaedic registry from June 2015 to December 2018 were analyzed. Patients were administered preoperative questionnaires including six Patient-Reported Outcome Measurement Information System domains and other activity and pain scales. Expectation scores were measured using the six domains of the Musculoskeletal Outcomes Data Evaluation and Management System expectations questionnaire. Bivariate and multivariable analyses were conducted to identify independent predictors of higher expectations.

Results Overall, patients had high expectations (≥ 80.0) of their hand surgery. Higher mean expectation scores were seen with females, college graduates, better baseline health status, and fewer prior hand surgeries (p < 0.05 for all). No significant associations were found among the Common Procedural Terminology codes and expectations. Multivariable analysis confirmed that college degree (p = 0.023) and less pain (p = 0.008) were predictive of higher baseline expectations.

Conclusion In sum, more educated patients with less pain at baseline and better baseline health status have higher expectations of their hand surgery. Hand surgeons can use these results to help focus their preoperative counseling and expectation management.



Publication History

Article published online:
07 June 2022

© 2022. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Pvt. Ltd.
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  • References

  • 1 Weiss AJ, Elixhauser A. Trends in Operating Room Procedures in U.S. Hospitals, 2001–2011: Statistical Brief #171. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006
  • 2 Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am 2012; 94 (03) 227-233
  • 3 Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 2010; 19 (08) 1115-1120
  • 4 Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 2012; 94 (03) 201-207
  • 5 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
  • 6 Cobb TK, Berner SH, Badia A. New frontiers in hand arthroscopy. Hand Clin 2011; 27 (03) 383-394
  • 7 Novak EJ, Vail TP, Bozic KJ. Advances in orthopaedic outcomes research. J Surg Orthop Adv 2008; 17 (03) 200-203
  • 8 Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN. Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 2013; 471 (11) 3446-3456
  • 9 Sciascia AD, Morris BJ, Jacobs CA, Edwards TB. Responsiveness and internal validity of common patient-reported outcome measures following total shoulder arthroplasty. Orthopedics 2017; 40 (03) e513-e519
  • 10 Squitieri L, Bozic KJ, Pusic AL. The role of patient-reported outcome measures in value-based payment reform. Value Health 2017; 20 (06) 834-836
  • 11 Feucht MJ, Cotic M, Saier T. et al. Patient expectations of primary and revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 201-207
  • 12 Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients' expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop 2009; 80 (01) 55-61
  • 13 Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery. Acta Orthop 2016; 87 (06) 615-621
  • 14 Tilbury C, Haanstra TM, Leichtenberg CS. et al. Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplasty 2016; 31 (10) 2139-2145
  • 15 Soroceanu A, Ching A, Abdu W, McGuire K. Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine 2012; 37 (02) E103-E108
  • 16 Mancuso CA, Altchek DW, Craig EV. et al. Patients' expectations of shoulder surgery. J Shoulder Elbow Surg 2002; 11 (06) 541-549
  • 17 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 35-43
  • 18 Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012; 94 (07) 974-981
  • 19 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 20 Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A. Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 2007; 16 (06) 752-758
  • 21 Oh JH, Yoon JP, Kim JY, Kim SH. Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 2012; 21 (06) 715-721
  • 22 Plath JE, Saier T, Feucht MJ. et al. Patients' expectations of shoulder instability repair. Knee Surg Sports Traumatol Arthrosc 2018; 26 (01) 15-23
  • 23 Henn III RF, Kang L, Tashjian RZ, Green A. Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 2007; 89 (09) 1913-1919
  • 24 Koorevaar RCT, Haanstra T, Van't Riet E, Lambers Heerspink OFO, Bulstra SK. The development of the patient expectations of shoulder surgery survey. J Shoulder Elbow Surg 2017; 26 (10) 1701-1707
  • 25 Kadzielski J, Malhotra LR, Zurakowski D, Lee SG, Jupiter JB, Ring D. Evaluation of preoperative expectations and patient satisfaction after carpal tunnel release. J Hand Surg Am 2008; 33 (10) 1783-1788
  • 26 Marks M, Audigé L, Reissner L, Herren DB, Schindele S, Vliet Vlieland TP. Determinants of patient satisfaction after surgery or corticosteroid injection for trapeziometacarpal osteoarthritis: results of a prospective cohort study. Arch Orthop Trauma Surg 2015; 135 (01) 141-147
  • 27 Sharrock C, Kennedy D, Spencer S. Patients' expectations, experiences and the determinants of satisfaction related to metacarpophalangeal arthroplasty. Musculoskelet Care 2014; 12 (03) 132-140
  • 28 Hageman MG, Briët JP, Bossen JK, Blok RD, Ring DC, Vranceanu AM. Do previsit expectations correlate with satisfaction of new patients presenting for evaluation with an orthopaedic surgical practice?. Clin Orthop Relat Res 2015; 473 (02) 716-721
  • 29 Gandhi R, Davey JR, Mahomed N. Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty 2009; 24 (05) 716-721
  • 30 Henn III RF, Ghomrawi H, Rutledge JR, Mazumdar M, Mancuso CA, Marx RG. Preoperative patient expectations of total shoulder arthroplasty. J Bone Joint Surg Am 2011; 93 (22) 2110-2115
  • 31 Riddle DL, Golladay GJ, Hayes A, Ghomrawi HMK. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: a cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24 (02) 354-361
  • 32 Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003; 18 (07) 872-878
  • 33 Briet JP, Hageman MG, Overbeek CL, Mudgal C, Ring DC, Vranceanu AM. Factors associated with met expectations in patients with hand and upper extremity disorders: a pilot study. Psychosomatics 2016; 57 (04) 401-408
  • 34 Henn III RF, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK. The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 2017; 8 (04) 301-307
  • 35 Nadarajah V, Stevens KN, Henry L. et al. Patients undergoing shoulder surgery have high preoperative expectations. Knee Surg Sports Traumatol Arthrosc 2020; 28 (07) 2377-2385
  • 36 Stevens KN, Nadarajah V, Jauregui JJ. et al. Preoperative expectations of patients undergoing knee surgery. J Knee Surg 2021; 34 (06) 612-620
  • 37 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 38 Sajak PM, Aneizi A, Gopinath R. et al. Factors associated with early postoperative survey completion in orthopaedic surgery patients. J Clin Orthop Trauma 2020; 11 (Suppl. 01) S158-S163
  • 39 Kim JH, Park EC. Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health 2015; 15: 783
  • 40 Bernstein DN, Houck JR, Gonzalez RM. et al. Preoperative PROMIS scores predict postoperative PROMIS score improvement for patients undergoing hand surgery. Hand (N Y) 2020; 15 (02) 185-193
  • 41 Ponzio DY, Chiu YF, Salvatore A, Lee YY, Lyman S, Windsor RE. An analysis of the influence of physical activity level on total knee arthroplasty expectations, satisfaction, and outcomes: increased revision in active patients at five to ten years. J Bone Joint Surg Am 2018; 100 (18) 1539-1548
  • 42 Egloff N, Wegmann B, Juon B, Stauber S, von Känel R, Vögelin E. The impact of anxiety and depressive symptoms on chronic pain in conservatively and operatively treated hand surgery patients. J Pain Res 2017; 10: 259-263
  • 43 Kumar K, Gulotta LV, Dines JS. et al. Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med 2017; 45 (03) 636-641
  • 44 Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief 2015; (189) 1-8
  • 45 Dart RC, Surratt HL, Cicero TJ. et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372 (03) 241-248
  • 46 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 2016; 65 (01) 1-49
  • 47 Johnson SP, Chung KC, Zhong L. et al. Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 2016; 41 (10) 947-957.e3
  • 48 Menendez ME, Mellema JJ, Ring D. Attitudes and self-reported practices of hand surgeons regarding prescription opioid use. Hand (N Y) 2015; 10 (04) 789-795
  • 49 Menendez ME, Loeffler M, Ring D. Patient satisfaction in an outpatient hand surgery office: a comparison of English- and Spanish-Speaking patients. Qual Manag Health Care 2015; 24 (04) 183-189
  • 50 Engstrand C, Kvist J, Krevers B. Patients' perspective on surgical intervention for Dupuytren's disease - experiences, expectations and appraisal of results. Disabil Rehabil 2016; 38 (26) 2538-2549
  • 51 Frouzakis R, Herren DB, Marks M. Evaluation of expectations and expectation fulfillment in patients treated for trapeziometacarpal osteoarthritis. J Hand Surg Am 2015; 40 (03) 483-490
  • 52 Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes. CMAJ 2001; 165 (02) 174-179
  • 53 Lozano Calderón SA, Paiva A, Ring D. Patient satisfaction after open carpal tunnel release correlates with depression. J Hand Surg Am 2008; 33 (03) 303-307
  • 54 Bae JY, Kim JK, Yoon JO, Kim JH, Ho BC. Preoperative predictors of patient satisfaction after carpal tunnel release. Orthop Traumatol Surg Res 2018; 104 (06) 907-909
  • 55 Parrish II RC, Menendez ME, Mudgal CS, Jupiter JB, Chen NC, Ring D. Patient satisfaction and its relation to perceived visit duration with a hand surgeon. J Hand Surg Am 2016; 41 (02) 257-62.e1 , 4
  • 56 Williams DM, Rhodes RE. The confounded self-efficacy construct: conceptual analysis and recommendations for future research. Health Psychol Rev 2016; 10 (02) 113-128
  • 57 Hidalgo Diaz JJ, Botero SS, Vernet P, Aguerre C, Facca S, Liverneaux P. The role of self-efficiency toward pain following surgical treatment of carpal tunnel syndrome. Hand Surg Rehabil 2016; 35 (06) 413-417
  • 58 Somerson JS, Bhandari M, Vaughan CT, Smith CS, Zelle BA. Lack of diversity in orthopaedic trials conducted in the United States. J Bone Joint Surg Am 2014; 96 (07) e56