Surgeon’s expectations do not predict the outcome of a total knee arthroplasty

Meijerink, Huub J; Brokelman, R. B. G.; Loon, C. J. M. van; Kampen, A. van; Malefijt, M.C. de Waal

doi:10.1007/s00402-008-0799-z

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…It is well accepted that differences exist between patients and surgeons regarding expectations and satisfaction after TKA and hip arthroplasty. 1,2 In a prospective study of 53 primary TKAs, the surgeon preoperatively and immediately assessed the difficulty of the TKA, as well as his or his satisfaction about how well the procedure went. After 1-year follow-up, boththe surgeon's and the patient's satisfaction-were assessed.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established and accepted that patients have different perceptions and expectations compared with their surgeons related to total hip and knee arthroplasty. 1,2 In addition, it has been reported that patients frequently have high and potentially unrealistic expectations for total knee arthroplasty. [3][4][5] Furthermore, patient exposure to media such as the Internet is prevalent and increasing, as is direct to consumer advertising, which may affect the perceptions and expectations they have for pain relief, function, and longevity after TKA.…”

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confidence: 99%

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Modern Perceptions and Expectations Regarding Total Knee Arthroplasty

2013

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It is established that patients and surgeons share different perceptions regarding total knee replacement (TKA). This study's objective was to determine patient perceptions regarding TKA as well as the influence of the various information sources in shaping these perceptions. All patients presenting with knee pain for evaluation of TKA were offered a questionnaire. Multivariate statistical analysis correlated response and demographic variables. Approximately 81% of patients felt the main reason for TKA was to alleviate pain, whereas only 19% felt return to sports-related activities was the main reason. Approximately 37% of patients felt TKAs should last for 20 years or more, which was strongly correlated with TV, newspaper, or Internet exposure (p ≤ 0.01). Approximately 38% of respondents had heard of partial knee replacement, whereas relatively few had received information regarding patient-specific, gender-specific, mobile-bearing, or high-flexion TKA designs. Men were likelier than women to get their information from friends, family, or another patient (p = 0.04). Although most respondents perceived pain relief as the primary goal, patients getting information from the media are likelier to expect TKA to last longer than 20 years. This suggests direct-to-patient marketing with such claims as 30-year durability may influence patient perceptions regarding TKA.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Modern Perceptions and Expectations Regarding Total Knee Arthroplasty

2013

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“…Nine studies 17,21,23,24,32,34,38,40,42 (4070 patients; 2096 preoperative and 2939 postoperative risk estimations) reported surgeons' accuracy in predicting longer-term outcomes, involving patients undergoing orthopaedic 17,32,34,40,42 , general 23,24,38 and neurosurgical 21,40 operations. Outcome measures were heterogeneous and included overall function 21 , pain improvement 23 , global outcome impression 34,40 , hernia recurrence rate 38 , length of hospital stay (LOS) 24 and long-term survival 17 .…”

Section: Long-term Outcomesmentioning

confidence: 99%

“…A number of studies 17,21,34,40,42 found that surgeons significantly and consistently overestimated functional, analgesic and overall satisfaction outcomes after spinal, orthopaedic and neurosurgical operations. A number of studies 17,21,34,40,42 found that surgeons significantly and consistently overestimated functional, analgesic and overall satisfaction outcomes after spinal, orthopaedic and neurosurgical operations.…”

Section: Long-term Outcomesmentioning

confidence: 99%

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

et al. 2020

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Background: The accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's 'gut feeling' or perception of risk correlates with patient outcomes and available risk scoring systems.Methods: A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation-specific morbidity and long-term outcomes.Results: Twenty-seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC).Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre-existing risk prediction models. Long-term outcomes were poorly predicted by surgeons, with AUC values ranging from 0⋅51 to 0⋅75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery.Conclusion: Surgeons consistently overestimate mortality risk and are outperformed by pre-existing tools; prediction of longer-term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision-making.

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“…However, to the best of our knowledge, this mediation effect is not yet studied. Moreover, numerous studies found that physicians' expectations are not always significantly associated with treatment outcomes [10,15,18,23,24]. For example, physicians generally are worse in predicting outcomes for TKA patients, who in general show less fulfilled expectations, lower improvement rates, longer duration of improvement, and lower level of satisfaction after surgery, than THA patients [15,18,25e31].…”

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confidence: 99%