Preoperative Factors Associated with 2-Year Postoperative Survey Completion in Knee Surgery Patients

Abstract

Patient-reported outcomes, such as the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, have become increasingly valued as measures of treatment. The purpose of the study was to determine preoperative factors associated with survey compliance 2 years after elective knee surgery. Five hundred patients, age 17 years and older, undergoing knee surgery from August 2015 and March 2017 were administered questionnaires preoperatively and 2 years postoperatively. Questionnaires included the International Knee Documentation Committee (IKDC) score, Numeric Pain Scales (NPS), International Physical Activity Questionnaire (IPAQ), and six PROMIS Domains for physical function, pain interference, social satisfaction, fatigue, anxiety, and depression. Three hundred sixty-five patients (73.0%) completed both the preoperative and the 2-year surveys. A decreased likelihood of survey completion was significantly associated with black race, lower income, government-sponsored insurance, smoking, opioid use, fewer previous surgeries, lower expectations, lower PROMIS social satisfaction, higher PROMIS pain interference, and lower IPAQ physical activity. Multivariable logistic regression analysis confirmed that black race and lower IPAQ activity level were independent predictors of lower survey completion at 2-year follow-up with an area under the curve (AUC) of 0.62. A more robust multivariable model that included all variables with p < 0.05 in the bivariate analysis had an AUC of only 0.70. This study identified multiple preoperative factors that were associated with lower survey completion 2 years after elective orthopaedic knee surgery; however, all the factors measured in this study were not strong predictors of survey completion.

Predictors of two-year patient satisfaction following elective knee surgery

“…black race, lower income, government-sponsored insurance, smoking, higher baseline pain, and lower physical activity); however, none were strong predictors of survey completion. 42 All surgeries were conducted at an academic orthopaedic surgery practice, which may not be generalizable to other settings with specific patient populations. Similarly, a variety of knee surgeries were included and the proportions of each procedure type may not be representative of other centers.…”

Are Social Deprivation and Low Traditional Health Literacy Associated With Higher PROMIS CAT Completion in Orthopaedic Surgery?

“…Yet, there is a lack of research examining issues affecting PROMIS questionnaire completion in orthopaedics, particularly across a range of subspecialties, patient populations with nonelective presenting etiologies, and with respect to social determinants of health. The existing evidence shows that decreased PROMIS completion is associated with older age [6,24], race [6,7,16,30], lower income [7,16], lower education level [30], upper extremity surgery [24,30], and government-sponsored insurance [6,30] among other variables. However, these studies were contextually limited by elective sports medicine settings [7,24], single provider experience [24], and socioeconomic exclusion of patients implicit in assessment of remote PROMIS completion via an active email address [7,16,30].…”

“…However, these studies were contextually limited by elective sports medicine settings [7,24], single provider experience [24], and socioeconomic exclusion of patients implicit in assessment of remote PROMIS completion via an active email address [7,16,30]. Moreover, these studies did not examine PROMIS completion in the context of other relevant overarching social determinants of health, such as social deprivation or health literacy [6,7,16,24,30]. This was specifically cited as a limitation in the largest analysis of orthopaedic PROM scores of which we are aware, as sociodemographic variables can be proxies of these determinants [6].…”

Predictors of Postoperative Patient-Reported Outcome Measure Response Rates Among Patients With Rotator Cuff Repair

“…16,19,30 PROM response rates for orthopaedic treatments have been shown to vary, ranging from 24% to 75% over follow-up periods typically ranging from 1 week to 2 years. 6,17,18,27 Rotator cuff repairs (RCRs) have a prevalence of 165 per 100,000 person-years in the United States and are increasing at a rate of 1.2% per year. 44 This increase is primarily driven by the increasing number of adults aged 50 to 64 in the population.…”

“…16,19,30 PROM response rates for orthopaedic treatments have been shown to vary, ranging from 24% to 75% over follow-up periods typically ranging from 1 week to 2 years. 6,17,18,27…”