| orthopedics

Patients Have Higher Postsurgery Expectations than Surgeons

Looking Into Medical Literacy and Patient Knowledge

Newswise — In the first-ever study to compare surgeon and patient expectations in foot and ankle surgery, research performed at Hospital for Special Surgery (HSS) in New York City has determined that two-thirds of patients have higher presurgical expectations than their surgeons. The paper, titled "Comparison of Patients' and Surgeons' Expectations in Foot and Ankle Surgery," is available online as part of the AAOS 2020 Virtual Education Experience.

“An in-depth understanding of what factors contribute to preoperative patient expectations is especially critical in foot and ankle surgeries, as there are a wide variety of surgeries in our subspecialty, each of which comes with different expectations,” said Scott Ellis, MD, a foot and ankle orthopedic surgeon at HSS and author of the study.

Patient expectations of orthopaedic procedures have been demonstrated to be strongly associated with clinical outcomes and postoperative satisfaction. While efforts to quantify the difference between patient and surgeon expectations have been undertaken in spine and total knee arthroplasty, among other subspecialties, few attempts have been made to measure this in foot and ankle surgery.

Working with researchers from Weill Cornell Medicine, the HSS team examined data from 202 patients, administering a 23-item survey that assessed expectations regarding pain, physical function, shoe wear, appearance, work, social activity and psychological factors. Surgeons were given the same survey and asked how much improvement they expected their patient to gain in those areas.

“We determined that 66.3% of patients had higher expectations than their surgeons, 21.3% had concordant expectations, and 12.4% had lower expectations,” said Dr. Ellis. “In addition, the study showed that the majority of patients who had worse preoperative PROMIS scores had higher postoperative expectations. We also found that depressed and anxious individuals had greater expectations than their surgeons, as did patients with a higher body mass index.”

Going forward, said Dr. Ellis, future research should delve into other potential factors such as medical literacy and patients’ knowledge of their condition, as well as the bond between surgeon and patient. “Ideally, we could construct a study that could follow patients out to one or two years so as to determine amongst those whose expectations were met, how they were fulfilled. In the meantime, we suggest that a preoperative educational class for foot and ankle patients would go a long way towards a rapprochement between patients and surgeons when it comes to expectations.”


Read the full press release on Newswise.