Skip to main content

Advertisement

SpringerLink
Log in

Higher preoperative expectations predict better outcomes in shoulder surgery patients

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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).

Results

The mean PE score was 86.2 ± 17.8. Greater PE were associated with significantly 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JA, Broadbent E et al (2016) Patients’ expectations predict surgery outcomes: a meta-analysis. Int J Behav Med 23:49–62

    Article  Google Scholar 

  2. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  Google Scholar 

  3. Brophy RH, Beauvais RL, Jones EC, Cordasco FA, Marx RG (2005) Measurement of shoulder activity level. Clin Orthop Relat Res 439:101–108

    Article  Google Scholar 

  4. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S et al (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63:1179–1194

    Article  Google Scholar 

  5. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B et al (2007) The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care 45:S3-s11

    Article  Google Scholar 

  6. Coronado RA, Seitz AL, Pelote E, Archer KR, Jain NB (2018) Are psychosocial factors associated with patient-reported outcome measures in patients with rotator cuff tears? A systematic review. Clin Orthop Relat Res 476:810–829

    Article  Google Scholar 

  7. Culliton SE, Bryant DM, Overend TJ, MacDonald SJ, Chesworth BM (2012) The relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty 27:490–492

    Article  Google Scholar 

  8. Dyck BA, Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2014) Associations between patient expectations of joint arthroplasty surgery and pre- and post-operative clinical status. Expert Rev Med Devices 11:403–415

    Article  CAS  Google Scholar 

  9. Fu MC, Chang B, Wong AC, Nwachukwu BU, Warren RF, Dines DM et al (2019) PROMIS physical function underperforms psychometrically relative to American Shoulder and Elbow Surgeons score in patients undergoing anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 28:1809–1815

    Article  Google Scholar 

  10. Gandhi R, Davey JR, Mahomed N (2009) Patient expectations predict greater pain relief with joint arthroplasty. J Arthroplasty 24:716–721

    Article  Google Scholar 

  11. Ghomrawi HMK, Lee LY, Nwachukwu BU, Jain D, Wright T, Padgett D et al (2020) Preoperative expectations associated with postoperative dissatisfaction after total knee arthroplasty: a cohort study. J Am Acad Orthop Surg 28:e145–e150

    Article  Google Scholar 

  12. Haff R, Lucente V, Van Raalte H, Olson G, Murphy M (2009) Validation of a new post surgical quality of life tool: the surgical satisfaction questionnaire (SSQ-8). Int Urogynecol J 20:S133–S133

    Google Scholar 

  13. Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald D, Simpson AH et al (2013) What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement. BMJ Open 3(4):e002525

    Article  Google Scholar 

  14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381

    Article  Google Scholar 

  15. Henn RF 3rd, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK (2017) The Maryland Orthopaedic Registry (MOR): Design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 8:301–307

    Article  Google Scholar 

  16. Henn RF 3rd, Kang L, Tashjian RZ, Green A (2007) Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 89:1913–1919

    Article  Google Scholar 

  17. Henry LE, Aneizi A, Nadarajah V, Sajak PM, Stevens KN, Zhan M et al (2020) Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery. J Clin Orthop Trauma 11:S829-s836

    Article  Google Scholar 

  18. Johnson C (2005) Measuring Pain. Visual analog scale versus numeric pain scale: what is the difference? J Chiropr Med 4:43–44

    Article  Google Scholar 

  19. Judge A, Cooper C, Arden NK, Williams S, Hobbs N, Dixon D et al (2011) Pre-operative expectation predicts 12-month post-operative outcome among patients undergoing primary total hip replacement in European orthopaedic centres. Osteoarthritis Cartilage 19:659–667

    Article  CAS  Google Scholar 

  20. Koorevaar RCT, Haanstra T, Van’t Riet E, Lambers Heerspink OFO, Bulstra SK (2017) The development of the patient expectations of shoulder surgery survey. J Shoulder Elbow Surg 26:1701–1707

    Article  Google Scholar 

  21. Lawrence C, Zmistowski BM, Lazarus M, Abboud J, Williams G, Namdari S (2017) Expectations of shoulder surgery are not altered by surgeon counseling of the patient. Joints 5:133–137

    Article  Google Scholar 

  22. Levinger P, Bartlett JR, Bergman NR, McMahon S, Menz HB, Hill KD (2019) The discrepancy between patient expectations and actual outcome reduces at the first 6 months following total knee replacement surgery. Knee Surg Sports Traumatol Arthrosc 27:2042–2050

    Article  Google Scholar 

  23. Lin BJ, Zhang T, Aneizi A, Henry LE, Mixa P, Wahl AJ et al (2021) Predictors of met expectations two years after knee surgery. J Orthop 25:10–15

    Article  Google Scholar 

  24. Mahomed NN, Liang MH, Cook EF, Daltroy LH, Fortin PR, Fossel AH et al (2002) The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 29:1273–1279

    Google Scholar 

  25. Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA et al (2008) Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res 466:424–431

    Article  Google Scholar 

  26. Mancuso CA, Jout J, Salvati EA, Sculco TP (2009) Fulfillment of patients’ expectations for total hip arthroplasty. J Bone Joint Surg Am 91:2073–2078

    Article  Google Scholar 

  27. Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg 11:587–594

    Article  Google Scholar 

  28. Mondloch MV, Cole DC, Frank JW (2001) Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. Can Med Assoc J 165:174–179

    CAS  Google Scholar 

  29. Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB (2015) Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 24:11–16

    Article  Google Scholar 

  30. Nadarajah V, Stevens KN, Henry L, Jauregui JJ, Smuda MP, Ventimiglia DJ et al (2020) Patients undergoing shoulder surgery have high preoperative expectations. Knee Surg Sports Traumatol Arthrosc 28:2377–2385

    Article  Google Scholar 

  31. Novak EJ, Vail TP, Bozic KJ (2008) Advances in orthopaedic outcomes research. J Surg Orthop Adv 17:200–203

    Google Scholar 

  32. Oh JH, Yoon JP, Kim JY, Kim SH (2012) Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 21:715–721

    Article  Google Scholar 

  33. Rauck RC, Swarup I, Chang B, Dines DM, Warren RF, Gulotta LV et al (2018) Effect of preoperative patient expectations on outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 27:e323–e329

    Article  Google Scholar 

  34. Rauck RC, Swarup I, Chang B, Ruzbarsky JJ, Dines DM, Warren RF et al (2019) Preoperative patient expectations of elective reverse shoulder arthroplasty. J Shoulder Elbow Surg 28:1217–1222

    Article  Google Scholar 

  35. Sciascia AD, Morris BJ, Jacobs CA, Edwards TB (2017) Responsiveness and internal validity of common patient-reported outcome measures following total shoulder arthroplasty. Orthopedics 40:e513–e519

    Article  Google Scholar 

  36. Squitieri L, Bozic KJ, Pusic AL (2017) The role of patient-reported outcome measures in value-based payment reform. Value Health 20:834–836

    Article  Google Scholar 

  37. Stevens KN, Nadarajah V, Jauregui JJ, Song X, Medina SH, Smuda MP et al (2021) Preoperative expectations of patients undergoing knee surgery. J Knee Surg 34:612–620

    Article  Google Scholar 

  38. Swarup I, Henn CM, Gulotta LV, Henn RF 3rd (2019) Patient expectations and satisfaction in orthopaedic surgery: a review of the literature. J Clin Orthop Trauma 10:755–760

    Article  Google Scholar 

  39. Swarup I, Henn CM, Nguyen JT, Dines DM, Craig EV, Warren RF et al (2017) Effect of pre-operative expectations on the outcomes following total shoulder arthroplasty. Bone Joint J 99-b:1190–1196

    Article  CAS  Google Scholar 

  40. Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A (2007) Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 16:752–758

    Article  Google Scholar 

  41. Tashjian RZ, Henn RF, Kang L, Green A (2006) Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am 88:536–540

    Google Scholar 

  42. Vajapey SP, Cvetanovich GL, Bishop JY, Neviaser AS (2020) Psychosocial factors affecting outcomes after shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 29:e175–e184

    Article  Google Scholar 

  43. Williams BT, Redlich NJ, Mickschl DJ, Grindel SI (2019) Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 28:453–460

    Article  Google Scholar 

  44. Zywiel MG, Mahomed A, Gandhi R, Perruccio AV, Mahomed NN (2013) Measuring expectations in orthopaedic surgery: a systematic review. Clin Orthop Relat Res 471:3446–3456

    Article  Google Scholar 

Download references

Acknowledgements

J. Kathleen Tracy, Ph.D.; Ali Aneizi, MD; Andrew G. Dubina, MD; Julio J. Jauregui, MD; Vidushan Nadarajah, MD; Patrick M.J. Sajak, MD: Joshua M. Abzug, MD; Ngozi M. Akabudike, MD; Craig H. Bennett, MD; W. Andrew Eglseder, MD; Jonathan D. Packer, MD; Ebrahim Paryavi, MD; Raymond A. Pensy, MD; Cameran I. Burt, Shaun H. Medina; Keyan Shasti; Alexander J. Wahl; and Michael P. Smuda for their assistance with data collection.

Funding

This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated. Grant number: BL1941007WS.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA

    Samir Kaveeshwar, Dominic J. Ventimiglia, Tina Zhang, Matheus B. Schneider, Leah E. Henry, S. Ashfaq Hasan, Mohit N. Gilotra & R. Henn Frank III

  2. Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Kali N. Stevens

Authors
  1. Samir Kaveeshwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kali N. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominic J. Ventimiglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tina Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matheus B. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leah E. Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Ashfaq Hasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohit N. Gilotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Henn Frank III
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SK and MBS participated in data extraction and analysis. SK, KNS, DJV, MBS, and LEH participated in manuscript drafting, table production, and editing/revision. SAH, MNG, RFH participated in manuscript editing and finalization. RFH participated in project conceptualization, oversight, manuscript editing and finalization. All authors read and approved the final manuscript.

Corresponding author

Correspondence to R. Henn Frank III.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

University of Maryland, Baltimore IRB approval was obtained for this project: HP-00062261.

Informed consent

All study participants provided informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaveeshwar, S., Stevens, K.N., Ventimiglia, D.J. et al. Higher preoperative expectations predict better outcomes in shoulder surgery patients. Knee Surg Sports Traumatol Arthrosc 31, 185–192 (2023). https://doi.org/10.1007/s00167-022-07053-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07053-9

Keywords

Search

Navigation