Expectations of Shoulder Surgery Are Not Altered by Surgeon Counseling of the Patient

Lawrence, Cassandra; Zmistowski, Benjamin; Lazarus, Mark D.; Abboud, Joseph A.; Williams, Gerald R.; Namdari, Surena

doi:10.1055/s-0037-1605585

Cited by 9 publications

(8 citation statements)

References 20 publications

(19 reference statements)

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“…This study identified associations with multiple patient characteristics that have not been previously reported as well as some divergent results from previous studies [2, 14, 23, 29]. Whereas the data here revealed that demographic measures such as ethnicity, employment, income, BMI, and tobacco and opioid use were associated with preoperative expectations, Lawrence et al found that there were no significant correlations between shoulder surgery patients’ expectations and demographics [23].…”

Section: Discussioncontrasting

confidence: 76%

Patients undergoing shoulder surgery have high preoperative expectations

Nadarajah

Stevens

Henry

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose 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. Methods 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. Results 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. Conclusion 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 IV.

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Section: Discussioncontrasting

confidence: 76%

Patients undergoing shoulder surgery have high preoperative expectations

Nadarajah

Stevens

Henry

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Mancuso et al demonstrated that PE were modifiable in THA and TKA patients [25]. However, Lawrence et al showed that in a small cohort of 41 patients, baseline patient expectations were not substantially altered by routine preoperative counseling with a shoulder surgeon [21]. It is important to consider if more positive expectations or more realistic expectations lead to superior outcomes.…”

Section: Discussionmentioning

confidence: 99%

Higher preoperative expectations predict better outcomes in shoulder surgery patients

Kaveeshwar

Stevens

Ventimiglia

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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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). ResultsThe mean PE score was 86.2 ± 17.8. Greater PE were associated with signiicantly 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.

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“…Prior study has shown that current mechanisms of preoperative counseling did not influence patients' preoperative expectations of shoulder surgery. 20…”

Section: Discussionmentioning

confidence: 99%

Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

Lawrence

Lazarus

Abboud

et al. 2021

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Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.

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Expectations of Shoulder Surgery Are Not Altered by Surgeon Counseling of the Patient

Cited by 9 publications

References 20 publications

Patients undergoing shoulder surgery have high preoperative expectations

Patients undergoing shoulder surgery have high preoperative expectations

Higher preoperative expectations predict better outcomes in shoulder surgery patients

Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

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