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.

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 Pain Assessment in Foot and Ankle Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Meghan Kelly ◽  
David Bernstein ◽  
Ashlee MacDonald ◽  
John Ketz ◽  
Adolph Flemister ◽  
...  
Keyword(s):  
Pain Management ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Pearson Correlation ◽  
Pain Level ◽  
Foot And Ankle ◽  
Moderate Correlation ◽  
Patient Reported ◽  
And Function

Category: Other Introduction/Purpose: The ability to accurately quantify a patient’s pain pre-operatively is advantageous in the preparation of post-operative expectations and pain management. The Numeric Pain Rating Scale (NPRS) is a popular method to identify patient pain level. Other patient reported outcomes are being collected, such as the Patient Reported Outcomes Measurement Information System (PROMIS) and has been suggested to be more accurate in measuring pain as well as physical function. The aim of this study was to 1) determine whether NPRS or PROMIS Pain Interference (PI) demonstrates a stronger association with physical function as determined by PROMIS Physical Function (PF) and 2) to determine which method better predicts post-surgical pain in a population of elective surgical foot and ankle patients. Methods: Prospective PROMIS PF, PI and NPRS (0-10) data was obtained for common foot and ankle elective surgical procedures (CPT codes 27698, 27870, 28285, 28289, 28300, 28705, 28730, 28750) from a multi-surgeon foot and ankle clinic between February 2015 until November 2017. Pearson correlation coefficients were used to determine the relationship between NPRS (0-10) and PROMIS domains (PI, PF) pre and post-operatively. Correlations were considered high (> 0.7), high moderate (0.6-0.69), moderate (0.4-0.6) or weak (<0.4). Results: A total of 502 patients found to have complete data sets and > 6 month follow up were evaluated (74% women, mean age 54+/- SD, mean follow-up 14.4 months, range 6-34 months). Pearson correlation evaluation of NPRS and PI revealed a moderate correlation in the pre- and postoperative setting. There was a high moderate negative correlation between PI and PF t-scores pre and postoperatively suggesting more pain and less function. However, the negative correlation between NPRS and PF pre- and postoperatively was weak indicating a poor relationship between NPRS pain assessment and function. There was a moderate correlation between pre- and postoperative scores in all domains of PROMIS while the correlation between pre- and postoperative NPRS scores was weak. Conclusion: In a population of elective surgical foot and ankle patients, the use of both NPRS and PROMIS can be utilized to assess pain level, however the PROMIS PI domain demonstrated a stronger relationship with PROMIS PF than NPRS. Furthermore, only the PROMIS domains demonstrated at least a moderate correlation between pre- and post-operative scores. PROMIS PI provides superior assessment of pre- and post-operative physical function and prediction of post-operative pain. PROMIS PI can be used to gauge a patient’s pre-operative level of pain and function and aid the surgeon in guiding post-operative patient expectations and pain management.

Evaluating Patients for Elective Outpatient Foot and Ankle Surgery: Insurance as a Predictor of Patient Outcomes

2019 ◽  
Vol 12 (6) ◽  
pp. 522-529
Author(s):  
Wajeeh Bakhsh ◽  
Sean Childs ◽  
Irvin Oh ◽  
Sam Flemister ◽  
Judy Baumhauer ◽  
...  
Keyword(s):  
Patient Selection ◽  
Patient Reported Outcomes ◽  
Elective Surgery ◽  
Pain Patient ◽  
Trauma Patients ◽  
Foot And Ankle ◽  
Missed Appointments ◽  
Ankle Surgery ◽  
Patient Reported

Background. Elective surgical procedures necessitate careful patient selection. Insurance level has been associated with postoperative outcomes in trauma patients. This study evaluates the relationship insurance level has with outcomes from elective foot and ankle surgery. Methods. Retrospective chart review was performed on patients who underwent elective surgery at a single center with 1-year follow-up. Patients were classified by insurance: under-/uninsured (Medicaid, Option plans) versus fully insured. Outcomes included narcotic refills, patient-reported outcomes (PROMIS) of pain, function, and mood, and compliance with follow-up visits. Statistical analysis involved mean comparison and multivariate regression modeling, with significance P < .05. Results. Cohort groups included 220 insured and 47 under-/uninsured. Outcomes between the insured and under-/uninsured groups differed significantly in narcotic refills (0.72 vs 1.74 respectively, P < .01), missed appointments (0.13 vs 0.62, P < .01), and PROMIS results (pain 54.5 vs 60.2; function 44.3 vs 39.5; mood 44.6 vs 51.3; P < .01). The change in PROMIS scores from preoperative to 1-year postoperative were different in pain (−7.3 vs −2.5, P = .03) and function (+6.3 vs +1.3, P = .04). Regression results confirm insurance as a significant factor (coefficient 0.27, P < .01). Conclusion. These results establish that under-/uninsured patients have worse pain, patient-reported outcomes, and functional outcomes after elective foot and ankle surgery, which may inform patient selection. Levels of Evidence: Level III: Retrospective cohort study

scholarly journals Tracking Patient Outcomes Following Foot and Ankle Surgery: The OFAR Experience 2018-2019

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0003
Author(s):  
Kenneth Hunt ◽  
Ross Benthien ◽  
Judith F. Baumhauer ◽  
Christopher DiGiovanni ◽  
Shanthan Challa ◽  
...  
Keyword(s):  
Data Collection ◽  
Patient Outcomes ◽  
Patient Reported Outcomes ◽  
Short Form ◽  
Healthy Population ◽  
Foot And Ankle ◽  
Aggregated Data ◽  
Postoperative Changes ◽  
Patient Reported ◽  
The Impact

Category: Patient Reported Outcomes Introduction/Purpose: Collection and reporting of Patient Reported Outcomes (PROs) has become an integral part of healthcare and healthcare research. In an effort to facilitate AOFAS member participation in secure and efficient patient outcomes data collection, the Orthopaedic Foot and Ankle Outcomes Research (OFAR) Network, a national collaborative surgical outcomes registry, was established in 2018 by and for AOFAS member surgeons and their patients. OFAR aims to collect, aggregate, and report PRO data using the measurement instruments developed by the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS). We hypothesize that multiple sites from a variety of health systems can successfully enroll patients into a secure, web-based registry, and that foot and ankle procedures will significantly improve patient reported function and pain. Methods: Since December 2018, seven OFAR pilot sites have been enrolling patients, including three private and four academic practices. Each enrolled patient completed a pre-operative assessment as well as post-operative assessments at 3 time points. Five PROMIS metrics were collected, including Physical Function CAT (PF), Pain Intensity Short Form (PInSF), Pain Interference CAT (PInCAT), Global Health Short Form, and Depression CAT. Pathways, a secure web platform accessible by both patients and providers, was utilized for data collection and storage. The platform also includes a provider dashboard that collects diagnosis, treatment, implant and complication data. The aggregated data was analyzed using Python (v3.6) along with Pandas (v0.23.4). Results: As of December 2018, 877 patients have been enrolled in OFAR. Patients were enrolled from both academic (57%) and private practice (43%) sites. The three most frequently encountered conditions were: ankle impingement, ankle fractures and ankle arthritis. The largest pre- to postoperative changes were seen in the PF and PInCAT scores which significantly improved at 6 months and 12 months for nearly all condition groups (Figure 1). Many of these improvements averaged 20 points on the PROMIS t-score scale, which represents two standard deviations in the PROMIS scoring system, and restored PInCAT and PF to 50 or better, the US healthy population average. There was a trend toward improvement in depression scores for most conditions, with substantial improvement following fracture treatment. Conclusion: We were able to successfully onboard multiple pilot sites, including community private practices without dedicated research resources, to enroll patients in the OFAR platform. Aggregated data demonstrate a significant improvement in PROMIS scores for all conditions treated. The library of information collected is automated, extensive and comprehensive. By aggregating outcomes following treatment by orthopaedic foot and ankle surgeons across practice settings, the OFAR database empowers an unprecedented scrutiny of ‘real world’ patient outcomes and related factors. This facilitates an increasingly granular assessment of the impact of conditions and treatments, enabling patients and providers alike to share in the decision-making process.

Exploring the expectation-actuality discrepancy: a systematic review of the impact of preoperative expectations on satisfaction and patient reported outcomes in spinal surgery

2016 ◽  
Vol 41 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Christopher D. Witiw ◽  
Alireza Mansouri ◽  
Francois Mathieu ◽  
Farshad Nassiri ◽  
Jetan H. Badhiwala ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Surgery ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
Preoperative Expectations ◽  
The Impact

Patient-Reported Allergies Do Not Predict Poorer PROMIS Function, Pain, and Depression Scores Following Foot and Ankle Surgery

2018 ◽  
Vol 39 (8) ◽  
pp. 949-953 ◽  
Author(s):  
Devon C. Nixon ◽  
Brian M. Cusworth ◽  
Jeremy J. McCormick ◽  
Jeffrey E. Johnson ◽  
Sandra E. Klein
Keyword(s):  
Physical Function ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Pain Interference ◽  
Foot And Ankle ◽  
Operative Outcomes ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Outcome Scores

Background: Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery. Methods: To determine if PRAs are linked to poorer operative outcomes, we retrospectively identified 159 patients who underwent elective foot and ankle surgery. PRA data were obtained via chart review, and patient-reported outcomes were assessed preoperatively and postoperatively via multiple domains, including Patient Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, and depression measures. Consistent with prior methodology, we compared outcome measures (preoperative, postoperative, and the change in outcome scores) between patients without self-reported allergies to patients with at least 1 PRA. Results: There were 159 patients studied; 79 patients had no allergies listed, and 80 patients had at least 1 PRA. Of the 80 patients with at least 1 PRA, there were a total of 170 possible allergies. There were no differences in preoperative, postoperative, or the change in outcome scores for all PROMIS measures (physical function, pain interference, and depression; P > .05) between patients with at least 1 PRA and those patients without any listed PRAs. Conclusions: We were unable to prove our hypothesis that PRAs were linked to poorer patient-reported outcomes following foot and ankle surgery. Closer review of the published reports linking PRAs to worse total joint arthroplasty outcomes revealed data that, while statistically significant, are likely not clinically relevant. Our negative findings, then, may in fact parallel prior studies on hip, knee, and shoulder arthroplasty patients. The presence of PRAs does not appear to be a risk factor for suboptimal outcomes in foot and ankle surgery. Level of Evidence: Level III, comparative series.

scholarly journals Great Expectations: Predicting Postoperative Expectation Fulfillment in Orthopaedic Foot & Ankle Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Jensen K. Henry ◽  
Andrew R. Roney ◽  
Amelia Hummel ◽  
Elizabeth Cody ◽  
Carol A. Mancuso ◽  
...  
Keyword(s):  
Short Form ◽  
Tendon Injury ◽  
Hallux Rigidus ◽  
Foot And Ankle ◽  
Postoperative Function ◽  
High Expectations ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Preoperative Expectations ◽  
The Relationship

Category: Other Introduction/Purpose: In foot and ankle surgery, the fulfillment of patients’ preoperative expectations is a unique and validated method to assess postoperative success. Expectation fulfillment is closely associated with postoperative outcomes, satisfaction, and patient-reported improvement. Ideally, foot and ankle patients should have realistic expectations of surgery so that they are appropriately prepared for their postoperative symptoms and function. Inappropriately high expectations may predispose to worse outcomes because patients have unrealistic views about what their surgery can actually accomplish. Conversely, inappropriately low expectations may represent a lack of motivation to improve or participate in rehabilitation and postoperative protocols. This study aimed to identify the relationship between preoperative expectations and postoperative fulfillment. These results may facilitate surgeon-patient communication and help patients prepare for their operation and their postoperative function. Methods: Adult patients undergoing elective foot and ankle surgery at a single center were prospectively enrolled. Demographics, diagnosis, and outcomes surveys (Short Form [SF]-12, Foot & Ankle Outcome Score, improvement, satisfaction) were collected. Preoperatively, each patient completed the Expectations Survey (range 0-100, with 100 indicating maximum expectations), which asks about anticipated improvement in domains like pain, ambulation, function, and shoewear. Two years after surgery, for each expectation cited preoperatively, patients answered how much improvement they actually achieved. Using a ratio of the postoperative and preoperative scores, a Fulfillment Proportion (FP) was calculated, along with the minimal clinically important difference (MCID). This permitted identification of patients with unfulfilled, fulfilled, and surpassed expectations. Bivariate correlations, chi-square analyses, and multivariate regressions with 95% confidence intervals (CI) were performed to identify the relationship between preoperative expectations, clinical variables, and postoperative expectation fulfillment. Results: There were 271/340 (80%) patients with 2-year follow-up, with mean age 55.4 years and 65% female. Most common diagnoses were hallux valgus (25%), flatfoot (11%), hallux rigidus (11%), ankle arthritis (10%), and chronic tendon injury (9%). Expectation fulfillment differed significantly with extent of preoperative expectations (Figure). Patients with average/high expectations had higher rates of unfulfillment compared to patients with low preoperative expectations (40-41% vs. 22%). Rates of surpassed expectations were highest in patients with low preoperative expectations (23%) compared to average (12%) or high (0%) preoperative expectations (p<.001). In multivariate regression, the greatest predictor of postoperative FP was the preoperative expectations score (p<.001), and lower preoperative expectations conferred a 3.2x (95% CI 1.6-6.2) greater likelihood of more expectations fulfilled (p=.001). Conclusion: Preoperative expectations were a significant predictor of expectation fulfillment after foot and ankle surgery. Lower preoperative expectations were associated with fulfilled or surpassed expectations after surgery, whereas high preoperative expectations were significantly more likely to be unmet. These findings may help guide whether patients’ expectations are realistic or inappropriate preoperatively. It is imperative for surgeons to consider and discuss patients’ expectations prior to surgery to ensure they have an appropriate understanding of their potential outcome. Further research should be directed to the extent that patients’ preoperative expectations can be modified in order to maximize postoperative satisfaction.

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