Postoperative Expectation Research Articles

The Impact of Scars After DIEP-Flap Breast Reconstruction on Satisfaction and HR-QoL: A Cross-Sectional Study Comparing BREAST-Q Scores.

Although deep inferior epigastric perforator (DIEP) flap breast reconstruction is the most widely used technique for autologous breast reconstruction, this technique leads to large scars in visible areas on breast and abdomen. So far, limited studies have thoroughly addressed the impact of breast and abdominal scars on satisfaction and Health-related Quality of Life (HR-QoL). This research aimed to determine whether women with no/minor scar symptoms after undergoing DIEP-flap breast reconstruction differ in satisfaction and perceived HR-QoL from women with symptomatic scars. In this cross-sectional survey study, women who had previously undergone DIEP-flap breast reconstruction completed an online survey. Patient-reported scar quality was assessed with the Patient and Observer Scar Assessment Scale (POSAS), and satisfaction and HR-QoL with BREAST-Q. Independent-samples t-tests were conducted to compare BREAST-Q scores between women with no/minor scar symptoms (POSAS overall opinion score 1-3) and women with symptomatic scars (POSAS overall opinion score 4-10). A total of 248 women completed the survey. Women with scar symptoms had significantly worse BREAST-Q scores on 'Satisfaction with breasts,' 'Physical well-being,' 'Psychosocial well-being' and, 'Sexual well-being' compared to women with no/minor scar symptoms (p ≤ 0.001). After DIEP-flap breast reconstructions, women with symptomatic breast and abdominal scars had a clinically relevant and statistically significant lower degree of satisfaction and HR-QoL compared to women who had no/minor scar symptoms. We therefore recommend to explicitly and repeatedly address inevitability of visible scars after DIEP-flap breast reconstruction, aiming to improve preoperative patient selection and post-operative expectation management. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Defining minimal clinically important difference, patient acceptable symptomatic state and substantial clinical benefit for the visual analog scale pain score after arthroscopic rotator cuff repair

IntroductionPatient satisfaction after arthroscopic rotator cuff repair (RCR) is commonly assessed with patient-reported outcome measures (PROMs), and there is an increased need to establish clinical relevance within these measures. The purpose of this study was to (1) define minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) for the visual analog scale (VAS) pain score in patients undergoing arthroscopic RCR, and (2) identify preoperative predictors of achieving each of these threshold values. MethodsData from consecutive patients who underwent primary arthroscopic rotator cuff repair study between 2010 and 2016 were prospectively collected. Baseline data and VAS pain scores were collected preoperatively and at 1 year and 2 years postoperatively. MCID, PASS and SCB were determined using an anchor-based approach, with anchor questions assessing postoperative satisfaction and expectation fulfillment. Multivariate logistic regression analysis was also used to identify preoperative predictors for achieving MCID, PASS, and SCB. ResultsA total of 286 patients were included in the final analysis, with an average age of 60.2 ​± ​10.4 and the majority being female (61.2%). The values for the VAS pain score identified to represent MCID, PASS, and SCB, respectively, at 1-year postoperatively were: 5, 2, and 1. The rates of achieving clinically significant improvement based on VAS were 60.5%, 63.3%, and 57.2%, respectively. A higher preoperative VAS was predictive for achieving MCID (odds ratio [OR], 1.84; P ​< ​0.01). ConclusionThis study identified threshold VAS pain scores of 5, 2, and 1 for achieving MCID, PASS, and SCB, respectively, at 1-year follow-up after arthroscopic rotator cuff repair. A higher preoperative VAS pain score was also identified as a statistically significant predictor of attaining MCID after arthroscopic rotator cuff repair. Level of EvidenceII.

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

The Use of a Personalized 3D Printed Model for Pre-Operative Education in Patients with Severe Periarticular Foot and Ankle Fractures

Category: Trauma; Other Introduction/Purpose: Complex periarticular foot and ankle fractures have shown to have significant psychosocial effects on patients such as developing catastrophizing behaviours and poor pain coping strategies. These factors have shown to influence patient satisfaction. Interestingly, a positive association exists between patient satisfaction and preoperative expectations being met. For patient expectations to be met, clear comprehensive preoperative education is required. 3D printing has gained popularity due to its benefits in preoperative planning as well as patient education. Our aims were to 1) investigate the impact of a personalized 3D printed model for patient education on pre- and post-operative expectations and overall satisfaction and 2) investigate the impact of this teaching modality on PROMS and their correlation to patient expectation and satisfaction. Methods: Twenty-eight patients presenting complex periarticular foot and ankle fractures (pilon, talus and calcaneus) were randomized to either control or intervention (3D). All patients underwent a preoperative standardized education session with or without a personalized 3D printed model. Patient expectation and satisfaction were quantified pre- and postoperatively using the MODEMS questionnaires while the following PROMs (VAS and SF-12) were assessed at 2 weeks, 3 months, 6 months and 12 months post-operatively. Results: No significant differences were found between groups for MODEMS pre- (p=0.329) and postoperative expectation (p=0.654), and satisfaction (p=0.411). While not statistically significant, there was a trend towards expectations being better met in the intervention group when compared to the control group (31.2% vs 43.5% respectively). Also, there were no significant differences between groups for VAS and SF-12 at different time points, expect for SF-12 at 3 months for physical component only. A strong positive correlation (0.905, p=0.013) was found between MODEMS preoperative expectation and VAS scores at 12 months in the intervention group. Conclusion: Although there were no significant differences found between groups for pre- and postoperative patient expectation and overall satisfaction at 12 months, there is a trend towards expectations being better met in the intervention group. This could indicate that lower and more realistic expectations are set preoperatively when educating patients using a 3D model. Expectations preoperatively are strongly correlated with pain scores at 12 months in the intervention group demonstrating an association with realistic expectations and improved pain scores when a 3D model was used. Thus, personalized 3D printed education is a non- invasive tool that may impact pain coping strategies post-operatively.

The influence of expectation modification in knee arthroplasty on satisfaction of patients: a randomized controlled trial.

Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment. In total, 204 primary TKA patients with osteoarthritis were enrolled in this randomized controlled trial (RCT). Patients were allocated to either usual preoperative education (control group) or usual education plus an additional module on realistic expectations (intervention group). Primary outcome was being very satisfied (numerical rating scale for satisfaction ≥ 8) with the treatment result at 12 months' follow-up. Other outcomes were change in preoperative expectations and postoperative expectation fulfilment. A total of 187 patients (91.7%) were available for analysis at follow-up. In the intention-to-treat analysis, 58.5% (55/94) of patients were very satisfied with the treatment result in the control group, and 69.9% (65/93) of patients in the intervention group (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 0.90 to 3.29). A per-protocol analysis for patients who attended the education session (92.0%, n = 172) showed that 56.9% (49/86) of patients were very satisfied in the control group and 74.4% (61/86) in the intervention group (AOR 2.44, 95% CI 1.21 to 4.91). After preoperative education, the expectation scores in the intervention group were significantly lower (mean difference -6.9 (95% CI -10.2 to -3.6)) and did not alter in the control group (mean difference 0.5 (95% CI -2.9 to 3.9)). Overall, fulfilment of expectations at 12 months was significantly higher in the intervention group (mean difference 11.4% (95% CI 2.3 to 20.5)). Improved preoperative patient education can modify patient expectations, resulting in higher postoperative fulfilment of expectation and higher satisfaction in the group that attended the preoperative education. This is the first RCT to confirm the potential of improved expectation management on satisfaction after TKA. Cite this article: Bone Joint J2021;103-B(4):619-626.

Evaluation of the relationship between patient expectation, patient expectation coverage rates and patient satisfaction in open primary septorhinoplasty surgery: a prospective randomized study.

The aim of this study was to evaluate the relationship between preoperative patient expectation and postoperative patient expectation coverage rates and patient satisfaction. 183 patients who underwent SRP for various reasons were divided into 6 groups according to surgical indication and the postoperative Rhinoplasty Outcome Evaluation Scale (ROE). The groups were evaluated in terms of preoperative expectation levels and postoperative expectation coverage rate. When the patients were evaluated in terms of preoperative expectation levels, a significant difference was determined between the patients who underwent surgery for cosmetic reasons (86.15 ± 8.61) and those with functional reasons (79.24 ± 6.62) (p < 0.001). Similarly, the lowest patient expectation coverage rates were in the patient group with cosmetic reasons for the operation. When patients were grouped according to the ROE scores in the postoperative period and surgical indication, expectation was higher in the groups that were not satisfied with the results (Groups 2, 4 and 6). The highest expectation levels among the groups were seen in the dissatisfied patients who had undergone surgery for cosmetic reasons (92.17 ± 4.96). A strong positive correlation was found between expectation coverage rates and patient satisfaction (r 0.907, p < 0.001). Determination and rationalization of the expectations of patients in the preoperative period is one of the factors that will increase the satisfaction of the patients about the surgical procedure.

Compilation and Analysis of Web-Based Orthopedic Personalized Predictive Tools: A Scoping Review.

Web-based personalized predictive tools in orthopedic surgery are becoming more widely available. Despite rising numbers of these tools, many orthopedic surgeons may not know what tools are available, how these tools were developed, and how they can be utilized. The aim of this scoping review is to compile and synthesize the profile of existing web-based orthopedic tools. We conducted two separate PubMed searches—one a broad search and the second a more targeted one involving high impact journals—with the aim of comprehensively identifying all existing tools. These articles were then screened for functional tool URLs, methods regarding the tool’s creation, and general inputs and outputs required for the tool to function. We identified 57 articles, which yielded 31 unique web-based tools. These tools involved various orthopedic conditions (e.g., fractures, osteoarthritis, musculoskeletal neoplasias); interventions (e.g., fracture fixation, total joint arthroplasty); outcomes (e.g., mortality, clinical outcomes). This scoping review highlights the availability and utility of a vast array of web-based personalized predictive tools for orthopedic surgeons. Increased awareness and access to these tools may allow for better decision support, surgical planning, post-operative expectation management, and improved shared decision-making.

Great Expectations: Predicting Postoperative Expectation Fulfillment in Orthopaedic Foot &amp; Ankle Patients

Category:OtherIntroduction/Purpose:In foot and ankle surgery, the fulfillment of patients’ preoperative expectations is a unique and validated method to assess postoperative success. Expectation fulfillment is closely associated with postoperative outcomes, satisfaction, and patient-reported improvement. Ideally, foot and ankle patients should have realistic expectations of surgery so that they are appropriately prepared for their postoperative symptoms and function. Inappropriately high expectations may predispose to worse outcomes because patients have unrealistic views about what their surgery can actually accomplish. Conversely, inappropriately low expectations may represent a lack of motivation to improve or participate in rehabilitation and postoperative protocols. This study aimed to identify the relationship between preoperative expectations and postoperative fulfillment. These results may facilitate surgeon-patient communication and help patients prepare for their operation and their postoperative function.Methods:Adult patients undergoing elective foot and ankle surgery at a single center were prospectively enrolled. Demographics, diagnosis, and outcomes surveys (Short Form [SF]-12, Foot & Ankle Outcome Score, improvement, satisfaction) were collected. Preoperatively, each patient completed the Expectations Survey (range 0-100, with 100 indicating maximum expectations), which asks about anticipated improvement in domains like pain, ambulation, function, and shoewear. Two years after surgery, for each expectation cited preoperatively, patients answered how much improvement they actually achieved. Using a ratio of the postoperative and preoperative scores, a Fulfillment Proportion (FP) was calculated, along with the minimal clinically important difference (MCID). This permitted identification of patients with unfulfilled, fulfilled, and surpassed expectations.Bivariate correlations, chi-square analyses, and multivariate regressions with 95% confidence intervals (CI) were performed to identify the relationship between preoperative expectations, clinical variables, and postoperative expectation fulfillment.Results:There were 271/340 (80%) patients with 2-year follow-up, with mean age 55.4 years and 65% female. Most common diagnoses were hallux valgus (25%), flatfoot (11%), hallux rigidus (11%), ankle arthritis (10%), and chronic tendon injury (9%). Expectation fulfillment differed significantly with extent of preoperative expectations (Figure). Patients with average/high expectations had higher rates of unfulfillment compared to patients with low preoperative expectations (40-41% vs. 22%). Rates of surpassed expectations were highest in patients with low preoperative expectations (23%) compared to average (12%) or high (0%) preoperative expectations (p<.001). In multivariate regression, the greatest predictor of postoperative FP was the preoperative expectations score (p<.001), and lower preoperative expectations conferred a 3.2x (95% CI 1.6-6.2) greater likelihood of more expectations fulfilled (p=.001).Conclusion:Preoperative expectations were a significant predictor of expectation fulfillment after foot and ankle surgery. Lower preoperative expectations were associated with fulfilled or surpassed expectations after surgery, whereas high preoperative expectations were significantly more likely to be unmet. These findings may help guide whether patients’ expectations are realistic or inappropriate preoperatively. It is imperative for surgeons to consider and discuss patients’ expectations prior to surgery to ensure they have an appropriate understanding of their potential outcome. Further research should be directed to the extent that patients’ preoperative expectations can be modified in order to maximize postoperative satisfaction.

Postoperative Analgesic Requirement and Pain Perceptions after Nonaerodigestive Head and Neck Surgery.

Little data exist on associations between patient factors and postoperative analgesic requirement after head and neck (H&N) surgeries. Such information is important for optimizing postoperative care considering concerns regarding opioid misuse. We analyzed factors associated with narcotic use and pain perception following H&N surgery sparing the upper aerodigestive tract. Prospective cohort. Tertiary referral center. From May to October 2017, data were collected for patients undergoing nonaerodigestive H&N procedures requiring hospitalization. Patients completed a preoperative survey querying chronic pain history, narcotic usage, and postoperative pain expectation. Demographics, surgical data, postoperative narcotic use defined by morphine milligram equivalents (MME), pain scores, and Overall Benefit of Analgesia Score (OBAS) were analyzed. Seventy-six patients, 44 (57.9%) females and 32 (42.1%) males with a mean age of 54.0 years, met inclusion criteria. The most common procedures were parotidectomy (27.6%) and total thyroidectomy (19.7%). Average cumulative 24-hour postoperative MME and calculated MME per hospital day (MME/HD, cumulative MME for hospitalization divided by length of stay) were 40.5 ± 30.6 and 60.8 ± 60.1, respectively. Average pain score throughout the initial 24 hours after surgery was 3.7/10 ± 2.0. Female sex and prior chronic pain diagnosis were associated with higher OBAS after multivariate linear adjustments. Postoperative narcotic requirement in nonaerodigestive H&N surgery is overall low. Female sex and prior chronic pain diagnosis may be associated with higher postoperative OBAS, a validated assessment of pain and opioid-related side effects. This study may serve as a comparison for future studies evaluating narcotic-sparing analgesia and pain perception in nonaerodigestive H&N surgery.

The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations

Aim: Breast cancer is the most common cancer in women and is the second most cause of cancer associated death. After diagnosis is made, emotional distress, anxiety and depression occurs in 35-38% of women. High anxiety levels prior to operation increases the sensitivity and expectation of the patients towrads pain, influencing the severity of postoperative pain. The aim of the present study was to evaluate the effect of preoperative anxiety on postoperative pain expectation, postoperative pain and opioid consumption in patients undergoing modified radical mastectomy. Material and Method: 60 female patients between the ages of 18-65 were included in the present study. Preoperative anxiety was evaluated using State Trait Anxiety Inventory (STAI) and postoperative pain expectation using Visual Analog Scale (VAS). STAI1 test was administered at preoperative visit, preoperatively and postoperative 6th hour while STAI2 was administered at preoeprative visit. Demographic characteristics were questioned. Postoperative pain levels and overall morphine consumption were recorded. Results: Postoperative STAI1 values were significantly lower than preoperative visit and preoperative STAI1 values (p=0.002 - p=0.004). Weak but statistically significant correlation was shown between preoperative visit STAI1 and STAI2 values. A statistically significant but weak positive relation was found betwen STAI1 preoperative and STAI1 postoperative 6th hour values and postoperative VAS (p=0.030; rho=0.280; p=0.003; rho=0.378). Median postperative pain expectation was found to be 6.0 (min=3.0; max=10.0). Conclusion: In the present study, it was demonstrated that high preoparetive anxiety scores are associated with increased postoperative pain level anxiety stimulations may potentiate pain, by exerting pain like effect via psychological system. It is our suggestion that, in special patient groups in which anxiety levels are high, such as breast cancer patients, planning postoeprative pain management after determining preoperative anxiety level and other risk factors will increase patient satsisfaction and the efficacy of analgesia.

Lateral Femoral Epicondylar Osteotomy for Correction of Fixed Valgus Deformity in Total Knee Arthroplasty: A Technical Note

BackgroundMultiple surgical techniques exist to restore limb alignment and to balance soft tissues in valgus knees during total knee arthroplasty (TKA). One technique is to perform a lateral femoral epicondylar osteotomy. MethodsA retrospective analysis was performed on all patients with a fixed valgus deformity that was corrected with a lateral femoral epicondylar osteotomy during TKA. Preoperative and postoperative Knee Society Knee Scores, knee stability, range of motion, and radiographic alignment were recorded. ResultsTen patients (3 male and 7 female) underwent 12 TKAs by a single surgeon using a lateral femoral epicondylar osteotomy to correct a fixed valgus deformity. Implants used included 7 posterior stabilized, 3 constrained posterior stabilized, and 2 constrained condylar knees. Average age was 68 years (range 48-89) and average follow-up was 34.7 months (4-109). Average postoperative range of motion was 125° of flexion (range 95°-145°). The mean radiographic preoperative and postoperative anatomic tibiofemoral angles were 16.4° of valgus (range 12°-26°) and 5.5° of valgus (range 4°-7°), respectively. The mean preoperative knee society objective, satisfaction, expectation, and functional activity scores were 71, 20, 11, and 30, respectively. The mean postoperative knee society objective, satisfaction, expectation, and functional activity scores were 88, 34, 13, and 64, respectively. There was 1 postoperative deep vein thrombosis and 1 temporary peroneal nerve palsy. ConclusionLateral femoral epicondylar osteotomy is a useful technique to restore mechanical alignment in fixed valgus deformities in TKA.

Patient-Reported Metal Allergy: A Risk Factor for Poor Outcomes After Total Joint Arthroplasty?

BackgroundMetal sensitivity after total joint arthroplasty has been of increased concern, but the impact of a patient-reported metal allergy on clinical outcomes has not been investigated. The purpose of this study was to report the incidence and impact of patient-reported metal allergy after total knee arthroplasty (TKA) and total hip arthroplasty (THA). MethodsThis was a retrospective, institutional review board–approved investigation of patients undergoing a primary, elective total joint arthroplasty between 2009 and 2011. All patients completed a preoperative questionnaire asking about drug and environmental allergies. In January 2010, a specific question was added regarding the presence of a metal allergy. University of California at Los Angeles Activity, Short Form 12 (SF-12), Modified Harris Hip, and Knee Society scores were collected preoperatively and at most recent follow-up. Overall cohorts of metal allergy and nonmetal allergy patients were compared, and a 1:2 matching analysis was also performed. ResultsNine hundred six primary THAs and 589 primary TKAs were included. The incidence of patient-reported metal allergy was 1.7% before January 2010 and 4.0% after (overall 2.3% of THAs and 4.1% of TKAs); 97.8% of metal allergy patients were female. After TKA, postoperative Knee Society Function, Symptoms, Satisfaction, and Expectation scores were all decreased in the metal allergy cohort (P < .001-.002). After THA, metal allergy patients had a decreased postoperative SF-12 Mental Component Score and less incremental improvement in their SF-12 Mental Component Score vs the nonmetal allergy cohort (P < .0001 and P = .001, respectively). ConclusionPatient-reported metal allergy is associated with decreased functional outcomes after TKA and decreased mental health scores after THA.

FRI0308 Reducing gender disparities in willingness to consider total knee replacement (TKR): The impact of a brief educational intervention

BackgroundStudies suggest patients’ willingness to consider TKR for osteoarthritis (OA) varies by gender and that women who undergo TKR have more severe OA and greater functional disability than men at...