Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-07-2020 | Opioids | SHOULDER

Patients undergoing shoulder surgery have high preoperative expectations

Authors: Vidushan Nadarajah, Kali N. Stevens, Leah Henry, Julio J. Jauregui, Michael P. Smuda, Dominic J. Ventimiglia, Mohit N. Gilotra, S. Ashfaq Hasan, R. Frank Henn III

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2020

Abstract

Purpose

The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery.

Methods

Data from a total of 319 patients (319 shoulders) from 2015–2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations.

Results

The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score.

Conclusion

The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction.

Level of evidence

IV.

Beckmann JT, Hung M, Bounsanga J, Wylie JD, Granger EK, Tashjian RZ (2015) Psychometric evaluation of the PROMIS Physical Function Computerized Adaptive Test in comparison to the American Shoulder and Elbow Surgeons score and Simple Shoulder Test in patients with rotator cuff disease. J Shoulder Elbow Surg 24:1961–1967CrossRef

Briet JP, Hageman MG, Overbeek CL, Mudgal C, Ring DC, Vranceanu AM (2016) Factors associated with met expectations in patients with hand and upper extremity disorders: a pilot study. Psychosomatics 57:401–408CrossRef

Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL (2012) National trends in rotator cuff repair. J Bone Jt Surg Am 94:227–233CrossRef

Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 19:1115–1120CrossRef

Doyle DJ, Garmon EH (2019) American Society of Anesthesiologists Classification (ASA Class). StatPearls. Treasure Island (FL). Cassell and Company, London

Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY et al (2016) 2013 neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg 25:1303–1311CrossRef

Dyck BA, Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2014) Associations between patient expectations of joint arthroplasty surgery and pre- and post-operative clinical status. Expert Rev Med Devices 11:403–415CrossRef

Gandhi R, Davey JR, Mahomed N (2009) Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty 24:716–721CrossRef

Gershon RC, Rothrock N, Hanrahan R, Bass M, Cella D (2010) The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research. J Appl Meas 11:304–314PubMedPubMedCentral

10.

Groeneveld PW, Kwoh CK, Mor MK, Appelt CJ, Geng M, Gutierrez JC et al (2008) Racial differences in expectations of joint replacement surgery outcomes. Arthritis Rheum 59:730–737CrossRef

11.

Hancock KJ, Glass N, Anthony CA, Hettrich CM, Albright J, Amendola A et al (2017) Performance of PROMIS for healthy patients undergoing meniscal surgery. J Bone Jt Surg Am 99:954–958CrossRef

12.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap) a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRef

13.

Henn RF 3rd, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK (2017) The maryland orthopaedic registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 8:301–307CrossRef

14.

Henn RF 3rd, Ghomrawi H, Rutledge JR, Mazumdar M, Mancuso CA, Marx RG (2011) Preoperative patient expectations of total shoulder arthroplasty. J Bone Jt Surg Am 93:2110–2115CrossRef

15.

Henn RF 3rd, Kang L, Tashjian RZ, Green A (2007) Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Jt Surg Am 89:1913–1919CrossRef

16.

Hung M, Baumhauer JF, Latt LD, Saltzman CL, SooHoo NF, Hunt KJ et al (2013) Validation of PROMIS (R) Physical Function computerized adaptive tests for orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 471:3466–3474CrossRef

17.

Hung M, Clegg DO, Greene T, Saltzman CL (2011) Evaluation of the PROMIS physical function item bank in orthopaedic patients. J Orthop Res 29:947–953CrossRef

18.

Hung M, Hon SD, Franklin JD, Kendall RW, Lawrence BD, Neese A et al (2014) Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976) 39:158–163CrossRef

19.

Hung M, Stuart AR, Higgins TF, Saltzman CL, Kubiak EN (2014) Computerized adaptive testing using the promis physical function item bank reduces test burden with less ceiling effects compared with the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma 28:439–443CrossRef

20.

Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK (2002) Differences in expectations of outcome mediate African American/white patient differences in “willingness” to consider joint replacement. Arthritis Rheum 46:2429–2435CrossRef

21.

Koorevaar RCT, Haanstra T, Riet E, Heerspink OFO, Bulstra SK (2017) The development of the patient expectations of shoulder surgery survey. J Shoulder Elbow Surg 26:1701–1707CrossRef

22.

Lavernia CJ, Contreras JS, Parvizi J, Sharkey PF, Barrack R, Rossi MD (2012) Do patient expectations about arthroplasty at initial presentation for hip or knee pain differ by sex and ethnicity? Clin Orthop Relat Res 470:2843–2853CrossRef

23.

Lawrence C, Zmistowski BM, Lazarus M, Abboud J, Williams G, Namdari S (2017) Expectations of shoulder surgery are not altered by surgeon counseling of the patient. Joints 5:133–137CrossRef

24.

Levin J (2006) Elementary statistics in social research. Pearson Education India, London

25.

Lingard EA, Sledge CB, Learmonth ID, Kinemax Outcomes Group (2006) Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Jt Surg Am 88:1201–1207

26.

Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME (1997) Patients' expectations and satisfaction with total hip arthroplasty. J Arthroplasty 12:387–396CrossRef

27.

Mondloch MV, Cole DC, Frank JW (2001) 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 165:174–179PubMedPubMedCentral

28.

Morgan JH, Kallen MA, Okike K, Lee OC, Vrahas MS (2015) PROMIS physical function computer adaptive test compared with other upper extremity outcome measures in the evaluation of proximal humerus fractures in patients older than 60 years. J Orthop Trauma 29:257–263CrossRef

29.

Oh JH, Yoon JP, Kim JY, Kim SH (2012) Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 21:715–721CrossRef

30.

Papuga MO, Beck CA, Kates SL, Schwarz EM, Maloney MD (2014) Validation of GAITRite and PROMIS as high-throughput physical function outcome measures following ACL reconstruction. J Orthop Res 32:793–801CrossRef

31.

Plath JE, Saier T, Feucht MJ, Minzlaff P, Seppel G, Braun S et al (2018) Patients' expectations of shoulder instability repair. Knee Surg Sports Traumatol Arthrosc 26:15–23CrossRef

32.

Rose M, Bjorner JB, Gandek B, Bruce B, Fries JF, Ware JE Jr (2014) The PROMIS Physical Function item bank was calibrated to a standardized metric and shown to improve measurement efficiency. J Clin Epidemiol 67:516–526CrossRef

33.

Swarup I, Henn CM, Nguyen JT, Dines DM, Craig EV, Warren RF et al (2017) Effect of pre-operative expectations on the outcomes following total shoulder arthroplasty. Bone Jt J 99:1190–1196CrossRef

34.

Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A (2007) Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 16:752–758CrossRef

35.

Tyser AR, Beckmann J, Franklin JD, Cheng C, Hon SD, Wang A et al (2014) Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 39(2047–2051):e2044

36.

Waljee J, McGlinn EP, Sears ED, Chung KC (2014) Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 155:799–808CrossRef

37.

Warth RJ, Briggs KK, Dornan GJ, Horan MP, Millett PJ (2013) Patient expectations before arthroscopic shoulder surgery: correlation with patients' reasons for seeking treatment. J Shoulder Elbow Surg 22:1676–1681CrossRef

38.

Weiss AJ, Elixhauser A (2006) Trends in operating room procedures in U.S. hospitals, 2001–2011: statistical brief #171. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD)

39.

Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2013) Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 471:3446–3456CrossRef

Title: Patients undergoing shoulder surgery have high preoperative expectations
Authors: Vidushan Nadarajah
Kali N. Stevens
Leah Henry
Julio J. Jauregui
Michael P. Smuda
Dominic J. Ventimiglia
Mohit N. Gilotra
S. Ashfaq Hasan
R. Frank Henn III
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Opioids
Opioids
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05824-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patients undergoing shoulder surgery have high preoperative expectations

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 7/2020

No difference between single and staged posterolateral corner surgical procedures in the multiligament injured/dislocated knee

The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury

Young age, female gender, Caucasian race, and workers’ compensation claim are risk factors for reoperation following arthroscopic ACL reconstruction

Electrocautery in arthroscopic surgery: intra-articular fluid temperatures above 43 °C cause potential tissue damage

Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally

An intact lacertus fibrosus improves strength after reinsertion of the distal biceps tendon