Patients undergoing shoulder surgery have high preoperative expectations
The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery.
Data from a total of 319 patients (319 shoulders) from 2015–2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations.
The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score.
The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction.
Level of evidence
KeywordsPROMIS Patient expectations Shoulder surgery Patient outcomes
This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study was approved by the Institutional Review Board (IRB) at the University of Maryland, Baltimore (HP-00062261).
- 1.Beckmann JT, Hung M, Bounsanga J, Wylie JD, Granger EK, Tashjian RZ (2015) Psychometric evaluation of the PROMIS Physical Function Computerized Adaptive Test in comparison to the American Shoulder and Elbow Surgeons score and Simple Shoulder Test in patients with rotator cuff disease. J Shoulder Elbow Surg 24:1961–1967CrossRefGoogle Scholar
- 5.Doyle DJ, Garmon EH (2019) American Society of Anesthesiologists Classification (ASA Class). StatPearls. Treasure Island (FL). Cassell and Company, LondonGoogle Scholar
- 19.Hung M, Stuart AR, Higgins TF, Saltzman CL, Kubiak EN (2014) Computerized adaptive testing using the promis physical function item bank reduces test burden with less ceiling effects compared with the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma 28:439–443CrossRefGoogle Scholar
- 24.Levin J (2006) Elementary statistics in social research. Pearson Education India, LondonGoogle Scholar
- 25.Lingard EA, Sledge CB, Learmonth ID, Kinemax Outcomes Group (2006) Patient expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Jt Surg Am 88:1201–1207Google Scholar
- 35.Tyser AR, Beckmann J, Franklin JD, Cheng C, Hon SD, Wang A et al (2014) Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 39(2047–2051):e2044Google Scholar
- 38.Weiss AJ, Elixhauser A (2006) Trends in operating room procedures in U.S. hospitals, 2001–2011: statistical brief #171. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD)Google Scholar