Satisfaction following surgery for hip, knee and spine osteoarthritis: the impact of physician-patient communication in the pre-surgical consultation

Abstract

Purpose: Patient satisfaction is an important measure of patient-centered outcomes and physician performance. Given the continued growth of the population undergoing surgical intervention for osteoarthritis, and the concomitant growth in the associated direct costs, understanding what factors drive satisfaction in this population is critical. A potentially important driver not previously considered is satisfaction with pre-surgical consultation. We investigated the influence of pre-surgical consultation satisfaction on overall satisfaction following surgery for osteoarthritis. Methods: Study data are from 1263 patients who underwent surgery for hip (n=480), knee (n=597), and spine (n=186) osteoarthritis at a large teaching hospital in Toronto, Canada. Before surgery, patients reported their satisfaction with the information received and the degree of input in decision-making during the pre-surgical consultation, along with expectations of surgery (regarding pain, activity limitation, expected time to full recovery and likelihood of complete success). Pre- and post-surgery (6 weeks, and 3, 6, and 12 months) patients reported their average pain level in the past week (0-10; 10 is worst). At each follow-up time-point, two pain variables were defined, pain improvement (minimal clinically important difference from baseline ≥2 points) and ‘acceptable’ pain (pain score ≤ 3). Patients also completed a question on satisfaction with the results of the surgery (very dissatisfied/dissatisfied/somewhat satisfied/very satisfied) at each follow-up time point. We used multilevel ordinal logistic regression to examine the influence of pre-surgery satisfaction with consultation on the trajectory of satisfaction over the year of recovery controlling for expectations of surgery, pain improvement, acceptable pain, socio-demographic factors (age, sex, and education), body mass index, comorbidity, and depressive symptoms (Hospital Anxiety and Depression Scale). Results: The sample mean age was 65.5 years and over half (54.3%) were women. Overall, 74.0% and 78.9% of patients were satisfied with the information received and with the decision-making in the pre-surgical consultation, respectively; no significant differences were found by surgical joint (p=0.22). Post-surgery, levels of satisfaction varied very little over time (6 weeks: 92.5% were satisfied and 66.4% were very satisfied; 1 year: 91.1% were satisfied and 65.6% were very satisfied). Results from a model including time, surgical joint, satisfaction with consultation and control factors indicated that being satisfied with the information received in the pre-surgical consultation was associated with higher odds of being more satisfied after surgery (OR: 1.2, 95% CI: 1.0-1.4). Additionally, spine and knee patients were more likely to be dissatisfied than hip patients (OR: 3.2, 95% CI: 2.1-4.9 and OR: 2.5, 95% CI: 1.8-3.4 for spine and knee patients respectively). Achieving pain improvement (OR: 1.7, 95% CI: 1.3-2.4) and acceptable pain (OR: 2.5, 95% CI: 1.6-3.9) were both significantly associated with greater satisfaction. Pre-operative expectations were not significantly associated with post-surgery satisfaction. Conclusions: Our findings highlight the important role of pre-surgery physician-patient communication and information on post-surgery satisfaction. This points to the need to ensure organizational provisions that foster supportive and interactive relationships between surgeons and their patients to improve patients’ satisfaction. The findings also highlight that early post-recovery period (i.e. <=3 months) as a key driver of longer-term satisfaction.