Fulfillment of Expectations After Orthopedic Foot and Ankle Surgery

Henry, Jensen K.; Roney, Andrew; Cody, Elizabeth; Hummel, Amelia; Mancuso, Carol A.; Ellis, Scott J.

doi:10.1177/1071100719864354

Cited by 22 publications

(31 citation statements)

References 29 publications

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“…Objective outcome measures such as the AOFAS score are correlated with patients’ expectations and satisfaction and are considered patient-centric outcomes. 12 Such objective scores and patient-reported outcome measures continue to efficiently measure the quality of healthcare provided to patients. 22…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Talectomy in Pediatric Feet

2021

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Background: Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot & Ankle Society (AOFAS) score and a subjective survey of patients’ and their caregivers’ satisfaction. Methods: We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. Results: Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children’s functional status posttalectomy. Conclusion: The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. Level of Evidence: Level III; retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Functional Outcomes of Talectomy in Pediatric Feet

2021

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“…A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. 8,14 The FP ranges from 0 (no expectations fulfilled), between 0 and 1 (expectations partially fulfilled), 1 (expectations met), to greater…”

Section: Methodsmentioning

confidence: 99%

“…3,4 In later work, patients were asked to complete a fulfillment questionnaire 2 years after surgery to quantify the extent to which a patient's expectations has been met following surgery. 8 Fulfillment of expectations is multifactorial and can depend on how well patients are informed and prepared prior to surgery, including an understanding of the goals of their operation, the expected outcomes, and the risk for potential complications. In addition, independent of how well patients are informed preoperatively, they may not remember or retain this information.…”

Section: Influence Of Complications and Revision Surgery On Fulfillment Of Expectations In Foot And Ankle Surgerymentioning

confidence: 99%

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

et al. 2021

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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.

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“…Patients' expectations of orthopedic surgery have previously been shown to be associated with their clinical outcomes and postoperative satisfaction, both in foot and ankle surgery and in total joint arthroplasty. 1,[9][10][11]15,16 The concordance between surgeon and patient expectations of surgery has also been studied in various orthopedic subspecialties, including spine, total knee arthroplasty (TKA), total hip arthroplasty (THA), and anterior cruciate ligament reconstruction. 7,8,[12][13][14]18 Within foot and ankle surgery, diagnosis and other patient demographic and clinical factors have been found to be associated with higher patient expectations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery

et al. 2020

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Background: Aligning patient and surgeon expectations may improve patient satisfaction and outcomes. This study aimed to assess differences in expectations of foot and ankle surgery between patients and their surgeons. Methods: Two hundred two patients scheduled to undergo foot or ankle surgery by one of 7 fellowship-trained foot and ankle surgeons were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey independently. Differences between patient and surgeon overall expectations scores, number of expectations, and number of expectations with complete improvement expected were assessed. A difference of ≥10 points was considered a clinically important difference in expectations score. Associations between patient demographic and clinical characteristics, major/minor surgery, and individual surgeon with differences in expectations were also assessed. Results: Overall, 66.3% of patients had higher expectations, 21.3% had concordant expectations, and 12.4% had lower expectations compared with their surgeons. On average, patients had higher expectations scores than their surgeons (70 ± 20 vs 52 ± 20 points, P < .001). Patients expected complete improvement in a greater number of expectations than surgeons (mean 11 ± 7 vs 1 ± 3, P < .001). Patients had higher expectations than surgeons for 18 of 23 items (78%). Items that had the greatest number of patients with higher expectations than surgeons were “improve confidence in foot/ankle,” “prevent foot/ankle from getting worse,” and “improve pain at rest.” Higher body mass index (BMI) ( P = .027) and individual surgeon ( P < .001) were associated with greater differences between patient-surgeon expectations. Major/minor surgery was not associated with differences in expectations ( P ≥ .142). Conclusion: More than two-thirds of patients had significantly higher expectations than their surgeons. Higher BMI was associated with higher patient than surgeon expectations. These results emphasize the importance for foot and ankle surgeons to adequately educate patients preoperatively. Level of Evidence: Level II, prospective comparative study.

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Fulfillment of Expectations After Orthopedic Foot and Ankle Surgery

Cited by 22 publications

References 29 publications

Functional Outcomes of Talectomy in Pediatric Feet

Functional Outcomes of Talectomy in Pediatric Feet

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

Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery

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