Influence of Complications and Revision Surgery on Fulfillment of Expectations in Foot and Ankle Surgery

2021 ◽  
pp. 107110072098523
Author(s):  
Bopha Chrea ◽  
Jonathan Day ◽  
Jensen Henry ◽  
Elizabeth Cody ◽  
Scott Ellis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Initial Surgery ◽  
Ankle Surgery ◽  
Patient Reported ◽  
The Impact

Background: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). Although this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to operating room for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring irrigation and debridement), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfillment survey was 15 (±3.6) months. The groups were similar in diagnoses. Results: Complications were associated with significantly worse FP (0.69 ± 0.45 vs 0.86 ± 0.40, P = .02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP ( P < .001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher Activities of Daily Living and Quality of Life scores ( P < .05). Demographically, there was no difference in age, sex, body mass index, Charlson Comorbidity Index, depression/anxiety, or pain management between the 2 groups. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery were associated with worse patient-reported fulfillment of their operative expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfillment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfillment as well as satisfaction following surgery. Level of Evidence: Level II, prospective comparative series.

scholarly journals Impact of Postoperative Complications on Fulfillment of Expectations after Orthopaedic Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Bopha Chrea ◽  
Jensen K. Henry ◽  
Jonathan Day ◽  
Andrew R. Roney ◽  
Elizabeth Cody ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Complications ◽  
Patient Reported Outcomes ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Removal Of Hardware ◽  
Preoperative Expectations ◽  
The Impact

Category: Other Introduction/Purpose: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied and validated in assessing patient-reported outcomes (PROs). While this assessment has been shown to correlate well with patient satisfaction and PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle expectations survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), between 0 and 1 (expectations partially fulfilled), 1 (expectations met), to greater than 1 (expectations surpassed). In addition, patient-reported outcomes (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (unplanned return to OR, reoperation, or revision). Results: Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication; 27 major (17 revisions, 10 removal of hardware due to pain/infection) and 6 minor (6 superficial infections requiring antibiotics). Complications were associated with significantly worse FP (0.69 +- 0.45 vs 0.86 +- 0.40, p=0.02). Average time from complication to completion of fulfillment survey was 15 (+-3.6) months. Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP (p<0.001). FAOS domains were similar preoperatively; postoperatively patients without complications had significantly higher ADL and QoL scores (p<0.05). Demographically, there was no difference in age, sex, BMI, Charlson Comorbidity Index, depression/anxiety, or pain management between the two groups. The groups were similar in diagnoses. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery are associated with worse patient-reported fulfillment of their surgical expectations. This finding is independent of preoperative expectations, and correlates with several validated outcomes measures including patient satisfaction. Therefore, while patient fulfillment following foot and ankle surgery is multifactorial, the importance of preoperative education and counselling for potential complications should not be overlooked.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

scholarly journals Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

2020 ◽  
Vol 10 (7) ◽  
pp. 896-907
Author(s):  
Eric O. Klineberg ◽  
Peter G. Passias ◽  
Gregory W. Poorman ◽  
Cyrus M. Jalai ◽  
Abiola Atanda ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Spinal Deformity ◽  
Surgical Outcomes ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Estimated Blood Loss ◽  
Patient Reported ◽  
The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

Preoperative Anxiety Effect on Patient-Reported Outcomes Following Foot and Ankle Surgery

2019 ◽  
Vol 40 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Devon C. Nixon ◽  
Kevin A. Schafer ◽  
Brian Cusworth ◽  
Jeremy J. McCormick ◽  
Jeffrey Johnson ◽  
...  
Keyword(s):  
Physical Function ◽  
Emotional Distress ◽  
Patient Reported Outcomes ◽  
Functional Disability ◽  
Preoperative Anxiety ◽  
Foot And Ankle ◽  
Preoperative Pain ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Patient Reported

Background: Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels. Methods: Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety. Results: Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, P < .001) and lower physical function (PROMIS PF: 37.9 vs 42.0, P = .001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, P < .001; PROMIS PF: 39.8 vs 44.4, P < .001; respectively). Conclusion: Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

scholarly journals PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics

2018 ◽  
Vol 40 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Maren W. Voss ◽  
Jerry Bounsanga ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Minimum Clinically Important Difference ◽  
Measurement Information ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Meaningful Change ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Level I

Background: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. Methods: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. Results: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. Conclusions: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. Level of Evidence: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.

scholarly journals Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

2018 ◽  
Vol 40 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Jerry Bounsanga ◽  
Maren W. Voss ◽  
...  
Keyword(s):  
T Test ◽  
Measurement Information ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Level Ii ◽  
Patient Reported ◽  
Prospective Comparative Study ◽  
Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

scholarly journals Validity of five foot and ankle specific electronic patient-reported outcome (ePRO) instruments in patients undergoing elective orthopedic foot or ankle surgery

2021 ◽  
Vol 27 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Mikko M. Uimonen ◽  
Ville T. Ponkilainen ◽  
Alar Toom ◽  
Mikko Miettinen ◽  
Arja H. Häkkinen ◽  
...  
Keyword(s):  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Reported

scholarly journals Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Wesley J. Manz ◽  
Rahul Goel ◽  
Omolola Fakunle ◽  
Sameh A. Labib ◽  
Jason T. Bariteau
Keyword(s):  
Patient Satisfaction ◽  
Clinic Visit ◽  
Continuous Data ◽  
Clinical Approach ◽  
Foot And Ankle ◽  
Office Visits ◽  
Chi Square ◽  
Fracture Care ◽  
Patient Reported ◽  
The Difference

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types. Methods: Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data. Results: 338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant. Conclusion: our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

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