Preoperative Evaluation of Patient Expectations for Symptomatic Improvement among Cubital Tunnel Release Patients
Chinelo C. Agwuncha, MS, Miranda J. Rogers, MD, MS, Jayden N. Brennan, BS and Nikolas H. Kazmers, MD MSE, University of Utah, Salt Lake City, UT
Introduction: Our purpose was to describe patient expectations prior to cubital tunnel release (CuTR) - which have yet to be elucidated - and identify preoperative factors associated with patient expectations.
Materials & Methods: This retrospective cohort study included patients treated with isolated (e.g. no other additional simultaneous procedures) CuTR between 2015 and 2021 at a tertiary academic medical center by one of five hand surgeons. Inclusion required a response to the following standardized question within 6 months preoperatively to assess expectations: "How much relief and/or improvement seems realistic to you as a result of the treatment you will be receiving?" Demographic, surgical, and other baseline factors were obtained via chart review and through electronic data query. Univariate followed by multivariable binary logistic regression with backward term elimination (α = 0.10) was performed to determine factors associated with expecting great improvement.
Results: Of 92 included patients, mean age was 48.5 ± 14.9 years and 65% were male. Additional baseline characteristics are provided in Table 1. Forty three (47%) patients expected great relief/improvement, whereas 27 (29%), 4 (4%), and 5 (5%) expected some, little, and no relief/improvement, respectively. Thirteen (14%) patients had no expectations. Multivariable analysis demonstrated that expectations were associated with insurance status and work status (Table 2) but not age, sex, surgical technique, revision versus primary CuTR, preoperative atrophy or constant numbness, diabetes, BMI and other factors (Table 2). This multivariable model yielded an area under-the-curve (AUC) of 0.80, consistent with excellent ability to discriminate between patients expecting great and lesser levels of improvement.
Conclusions: We found that roughly half of patients expect great relief, and a third expect lesser degrees of relief, following CuTR. Retired, disabled, and unemployed patients had significantly lower expectations. Commercially insured patients had lower expectations (versus Medicare or Medicaid), independent of age and social deprivation. Patient expectations were not associated with a variety of factors shown in prior literature to yield worse clinical outcomes or higher revision rates following CuTR (revision versus primary CuTR, preoperative atrophy or constant numbness, diabetes, BMI). This highlights an opportunity for refinement in patient preoperative counseling.
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