Higher preoperative expectations predict better outcomes in shoulder surgery patients

Abstract

Purpose The purpose of this study is to determine if preoperative expectations (PE) are an independent predictor of greater 2-year outcomes and greater improvement from baseline in shoulder surgery patients. Methods Two-hundred and sixteen patients who underwent shoulder surgery at one institution were studied. Patients completed both preoperative and 2-year follow-up questionnaires including PROMIS (Patient-Reported Outcome Measurement Information System) computer-adaptive testing in six domains, American Shoulder and Elbow Surgeons (ASES) score, shoulder numeric pain scale (NPS), and the Marx Shoulder Activity Rating Scale (MARS). PE were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) expectations domain, and satisfaction was measured via the Surgical Satisfaction Questionnaire (SSQ-8). ResultsThe mean PE score was 86.2 ± 17.8. Greater PE were associated with signiicantly better 2-year scores for ASES, NPS, MARS, SSQ8, and PROMIS domains of Physical Function, Fatigue, Pain Interference Fatigue and Social Satisfaction. Multivariable analyses demonstrated that greater PE were an independent predictor of both better 2-year scores and greater improvement for PROMIS SS (p < 0.001), ASES (p = 0.007), and shoulder NPS (p = 0.011). Conclusion Greater PE are positively associated with numerous patient-based outcomes 2 years after surgery. With regards to pain relief, shoulder function, and social satisfaction, higher PE are also predictive of better outcome scores and more improvement. This study suggests that preoperative assessment of shoulder surgery PE is important, and that counseling patients to optimize realistic expectations may lead to superior outcomes. Level of evidence III.

Comparison of Patients’ and Surgeons’ Expectations before Shoulder Arthroplasty

“…They demonstrated that patients’ expectations towards the outcome of surgery are dependent on diagnosis, demographics and functional status and developed a template for surgeons to discuss realistic and unrealistic goals with the patient and consequently improve shared decision making [ 11 ]. Kaveeshwar et al interviewed 216 patients who underwent shoulder surgery, showing that greater expectations are predictive for better outcome scores with reference to pain relief, shoulder function and social satisfaction [ 29 ].…”

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

“…We found that higher degrees of pain, reduced function in performing ADL, and lower expectations were important contributing factors to being ready for surgery. Role of preoperative expectations in final outcomes have been extensively examined 13,[50][51][52] and achievable expectations for joint replacement surgery are associated with better overall satisfaction. The evidence suggests that patients tend to overestimate the potential benefit of surgery and underestimate the potential for complications.…”

Psychology in orthopedics and traumatology: an instructional review

“…Also a variety of mental factors, such as anxiety ( 13 ), depression ( 13 ), pain catastrophizing ( 14 ), personality (e.g. emotional stability/neuroticism) ( 15 , 16 , 17 ), coping mechanisms ( 18 , 19 , 20 ), resilience ( 21 ), expectations ( 22 , 23 , 24 ), self-efficacy ( 25 ), and illness perceptions ( 26 ), are mentioned to influence symptoms before and after surgery. Since these factors can overlap, coincide, oppose, or enhance each other, we choose the most mentioned in the literature to discuss in this paper and we do not claim to be complete in reviewing the existing literature.…”