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Unmet Expectations But Satisfied Elective Hand Surgery Patients
Madeline K Mueller, MS, Bryce F Rizvanovi?, BS; Daniel A London, MD, MS
University of Missouri, Columbia, MO
IntroductionIt is unknown how patients' post-operative expectations influence their satisfaction with elective hand surgery. We hypothesized that patients who were dissatisfied with their surgical outcome would have a larger discrepancy between their expected improvement after surgery compared to their actual improvement, as measured by PROMIS Upper Extremity (PROMIS UE), when compared to patients who were satisfied with their surgery.
Materials & MethodsPatients undergoing elective hand surgery provided their baseline extremity function as measured by PROMIS UE v2.1. Prior to surgery, patients completed the PROMIS UE questionnaire a second time, imagining how they hoped their function would be after they were fully recovered from surgery. Six months post-operatively, final upper extremity function was measured by PROMIS UE, and satisfaction with the surgical outcome was measured by the ICHOM 3-question satisfaction questionnaire. The difference between achieved and expected improvements in PROMIS UE scores was compared between groups based on their satisfaction using ANOVA analyses.
Results 131 patients had complete 6-month data. Overall, patients expected a mean of 10.4 points (SD: 9.4) of improvement in their function after surgery as measured by PROMIS UE. On average, they achieved a 5.1 point (SD: 8.9) increase in their PROMIS UE scores. There was a significant difference between patients' expected and actual recovery (5.3 points, SEM: 0.9, p<0.05). Most patients had varying levels of satisfaction with their outcome (Table 1), would repeat surgery (117/131, 89.3%), and would recommend their surgery to family/friends (116/131, 88.5%). 7-point satisfaction levels were significantly associated with the difference between expected and actual achieved improvements in function (p<0.05, Table 1). On average, no groups that were satisfied with their surgical outcome outperformed their pre-operative expectations.
ConclusionPatients' desired improvement, as measured by PROMIS UE, of 10.4 points exceeds the published MCID value range of 3.0 to 4.1. On average, 6 months after elective hand surgery, patients do not meet their pre-operative expectations as measured by PROMIS UE, but still achieve a level of improvement greater than the MCID. Even when stratified by satisfaction level, on average, no group's post-operative function was equal to or greater than their pre-operative expectations. However, despite this discrepancy, most patients are satisfied with their surgical outcome. These results question whether PROMIS UE asks questions that accurately reflect patients' experiences and goals related to their hand/wrist function.
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