Patients undergoing shoulder surgery have high preoperative expectations

Abstract

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.

Association of Preoperative Opioid Use With Complication Rates and Resource Use in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

“…The relationship between opioids and psychosocial aspects of health is also complex. Evidence has suggested that opioid use may result in unrealistic expectations about pain management after surgery 37 and may aggravate the anxiety associated with painful stimuli. 53 Perhaps, then, it is not surprising that a relationship with opioid misuse exists between both active cigarette smoking and drug/alcohol abuse syndromes.…”

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

“…Our findings agree with those identified in total hip and knee arthroplasty studies, which have demonstrated increased rates of infections, 10 revision surgery, 6,7,56 and readmissions 56 in patients taking opioids before surgery. There are several mechanisms by which preoperative opioid use may be driving these complications, including increased postoperative analgesic requirements, 1,35,57,58 unrealistic postoperative expectations for surgery, 34 increased dissatisfaction with surgery, 22,30 and opioid-associated delayed wound healing and impaired immunological functioning. 39,49 Furthermore, we add to the literature another risk factor for detrimental postoperative outcomes in those undergoing RCR, which previously included patient age, 29 body mass index, 5 comorbidities, 46,53 open repair, 38 and preoperative and intraoperative steroid injections.…”

Preoperative Expectations in Hand Surgery Patients

“…We chose to include adolescents to better elucidate any possible relationships between age and expectations and the youngest patient in the cohort was 15 years old. 35,36 All enrolled patients were given the following questionnaires preoperatively: Patient-Reported Outcome Measurement Information System (PROMIS) PF, PROMIS pain interference, PROMIS fatigue, PROMIS social satisfaction, PROMIS anxiety, PROMIS depression, Brief Michigan Hand Questionnaire, MODEMS expectations questionnaire, Tegner activity scale (Tegner), Marx activity rating scale, and numeric pain scale (NPS) for both the operative hand and the rest of the body. MODEMS asks patients what results they expect from their treatment on a five-point Likert scale ranging from "not at all likely" (1) to "extremely likely" (5).…”