Patient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management

doi:10.1016/j.arthro.2017.03.004

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 33, Issue 8, August 2017, Pages 1603-1606

https://doi.org/10.1016/j.arthro.2017.03.004 Get rights and content

Abstract

Rotator cuff injuries are among the most common in orthopaedics, with rotator cuff repair surgery consistently reported as one of the most commonly performed orthopaedic procedures. Patient satisfaction is becoming an increasingly important outcome metric as health care continues to evolve with regard to quality measures affecting physician reimbursement. Evidence supports that postoperative patient satisfaction, an important quality outcome metric, is highly influenced by preoperative patient expectations, which are in turn governed by patient knowledge and understanding. Many authors have delineated patient-, injury-, and surgery-specific variables associated with high preoperative expectations and satisfaction after rotator cuff surgery. Specifically, large rotator cuff tears, subscapularis tears, persistence of postoperative pain and dysfunction, worker's compensation cases, lower education level, and preoperative disability have been seen more frequently in patients reporting poor satisfaction. Others have reported variables associated with higher patient satisfaction such as being married, employed, and of older age at the time of surgery (>55 years old) predictive of higher satisfaction. Patient education preoperatively regarding details about the surgery and the postoperative plan both immediately after the procedure and for rehabilitation are critical in helping set patients' preoperative expectations that have a known effect on patients' subjective clinical outcomes.

Section snippets

Introduction: Association Between Patient Understanding, Expectations, and Satisfaction

Patient satisfaction and patient-reported outcomes (PROs) are becoming increasingly important outcome metrics as orthopaedics and health care in general strive for a more patient-centered model. Pain and functional limitation are frequently driving factors for patients seeking intervention, and patients have variable expectations of the level of improvement that they will experience after surgery.¹ Although many variables influence patient satisfaction with orthopaedic surgery, a key

Patient Education: Rotator Cuff Injuries and Surgical Management

Rotator cuff injuries affect about 17 million people in the United States and are among the most common presentations for orthopaedic care.7, 8 Rotator cuff repair surgery is one of the most common orthopaedic procedures with an estimated 200,000 to 300,000 repairs each year.⁹ Although a paucity of information exists regarding patient understanding/perception of rotator cuff injuries and management options, many have reported on the quality of patient education materials with regard to rotator

Patient Expectations and Concerns for Rotator Cuff Surgery

Many investigators have sought to elucidate patient-specific and injury-specific factors that influence expectations and concerns for surgical management of rotator cuff tears. In a prospective study of 125 patients who underwent primary repair for chronic rotator cuff tears, Henn et al.¹⁷ evaluated preoperative patient expectations. They used 6 questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire, and obtained PROs both preoperatively and

Factors Influencing Patient Satisfaction With Rotator Cuff Surgery

As Makhni et al.²¹ showed in their recent systematic review of outcome assessment measures for rotator cuff pathology, obtaining patient satisfaction scores has not yet become routine for many orthopaedic practices. However, there is little doubt regarding the significance of patient satisfaction scores going forward. O'Holleran and colleagues²² evaluated determinants of patient satisfaction after rotator cuff surgery. In their cohort of 57 patients with minimum 1-year follow-up, the authors

Discussion

Although this evidence is important for treating providers to be aware of when counseling patients, the approach to counseling should be patient specific. It is essential to understand and address patients' individual concerns and goals for treatment. Patients often present to orthopaedic surgeons with limited knowledge regarding their injury and management options. Information is often obtained from the internet, frequently through sources with low-quality, difficult-to-understand content

Conclusions

Many factors affect patient satisfaction after rotator cuff surgery. Large rotator cuff tears, subscapularis tears, persistence of postoperative pain and dysfunction, worker's compensation cases, lower education level, and preoperative disability are more frequently seen in patients reporting poor satisfaction. Comparatively, being married, employed, and of older age at the time of surgery (>55 years old) predicts higher satisfaction. Patient education preoperatively regarding details about the

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Cited by (29)

Female Sex and Higher Infraspinatus Fatty Infiltration Are Linked to Dissatisfaction at a Minimum Follow-Up of 4 Years after Arthroscopic Repair of Massive Rotator Cuff Tears
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To evaluate patient satisfaction at a minimum of 4 years after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCT), to identify preoperative and intraoperative characteristics associated with satisfaction, and to compare clinical outcomes between satisfied and dissatisfied patients.
A retrospective review on prospectively collected data was conducted on ARCRs of MRCTs performed at 2 institutions between January 2015 and December 2018. Patients with a minimum 4-year follow-up, preoperative and postoperative data, and primary ARCR of MRCTs were included for analysis. Patient satisfaction was analyzed according to patient demographics, patient-reported outcome measures (American Shoulder and Elbow Surgeons score [ASES], visual analog scale [VAS] for pain, Veteran Rands 12-item health survey [VR-12], and Subjective Shoulder Value [SSV]), range of motion (forward flexion [FF], external rotation [ER], and internal rotation [IR]), tear characteristics (fatty infiltration, tendon involvement, and tear size), and clinical significant measures (minimal clinical important difference [MCID], substantial clinical benefit [SCB], and patient-acceptable symptomatic state [PASS]) for ASES and SSV. Rotator cuff healing was also assessed with ultrasound in 38 patients at final follow-up.
A total of 100 patients met the study’s criteria. Overall, 89% of patients were satisfied with ARCR of a MRCT. Female sex (P = .007) and increased preoperative infraspinatus fatty infiltration (P = .005) were negatively associated with satisfaction. Those in the dissatisfied cohort had significantly lower postoperative ASES (80.7 vs 55.7; P = .002), VR-12 (49 vs 37.1; P = .002), and SSV scores (88.1 vs 56; P = .003), higher VAS pain (1.1 vs 4.1; P = .002) and lower postoperative range of motion in FF (147° vs 117°; P = .04), ER (46° vs 26°; P = .003), and IR (L2 vs L4; P = .04). Rotator cuff healing did not have an influence on patient satisfaction (P = .306). Satisfied patients were more likely to return to work than dissatisfied patients (97% vs 55%; P < .001).
Nearly 90% of patients who undergo ARCR for MRCTs are satisfied at a minimum 4-year follow-up. Negative preoperative factors include female sex and increased preoperative infraspinatus fatty infiltration, but no association was observed with rotator cuff healing. Furthermore, dissatisfied patients were less likely to report a clinically important functional improvement.
Level IV, prognostic case series.
Return to Sport Following Distal Triceps Repair
2023, Journal of Hand Surgery
The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport.
Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation.
Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up.
Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair.
Therapeutic IV.
Preoperative Expectations Do Not Correlate With Postoperative iHOT-33 Scores and Patient Satisfaction Following Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Patients’ expectations, and the fulfillment of such expectations, have been demonstrated to be strong predictors of surgical outcomes and satisfaction.1,2,3,4
To examine the correlation between preoperative patient expectation and International Hip Outcome Tool (iHOT-33) score and postoperative satisfaction of patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome.
Patients scheduled for surgery completed the Hip Preservation Surgery Expectations Survey (HPSES), as well as the preoperative and a minimum 2-year postoperative iHOT-33. Patient demographics that were collected included gender, age, occupation, and body mass index (BMI). At the latest follow-up, patients were evaluated for their subjective satisfaction and postoperative complications. An in-depth analysis was performed to assess the correlation between HPSES, iHOT-33, and patient satisfaction.
Sixty-nine patients (62.3% males; mean age: 33.7 ± 13.1 years; BMI: 23.9 ± 3.5 kg/m²) were included in this study. The mean HPSES score was 83.8 ± 16.5. The mean iHOT-33 improved from 31.6 ± 15.8 preoperatively to 73 ± 25.9 postoperatively (95% CI = 35.2,47.8; P < .01), and the mean patient satisfaction was 75.9 ± 26.9. There were no statistically significant differences in mean HPSES score between males and females (95% CI = 79.9,87.8; P = .35) nor between different occupational groups (95% CI = 79.4,87.6, P = .095). No correlation was found between age and HPSES score (r = .036; P =.76). There was a negligible correlation between HPSES score and postoperative iHOT-33 score (r = −.117; P = .34) and patient satisfaction (r = −.042; P = .73). Postoperative iHOT-33 score had a significant high correlation with patient satisfaction (r = .8; P < .001).
Preoperative expectations do not correlate with postoperative iHOT-33 scores and patient satisfaction with surgery at 2 years after surgery. Gender and occupation did not differ significantly with regard to preoperative expectations, and there was no correlation between age and HPSES score.
IV, retrospective case series.
High Rate of Return to Work by 3 Months Following Latarjet for Anterior Shoulder Instability
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
Patients without workers compensation may experience greater subjective improvement and may be more motivated to return to work. Nonetheless, preoperative patient expectations have been shown to impact clinical outcomes.59,60 The results of this study can help to support the counseling of the patient undergoing shoulder stabilization in terms of expectations and satisfaction.
To evaluate the rate and duration of return to work in patients undergoing Latarjet for failed soft-tissue stabilization or glenoid bone loss.
Consecutive patients undergoing Latarjet from 2005 to 2015 at our institution were retrospectively reviewed at a minimum of 2 years postoperatively. Patients completed a standardized and validated work questionnaire, Western Ontario Shoulder Instability Index Survey, and a satisfaction survey.
Of 89 eligible patients who had Latarjet, 67 patients (75.3%) responded to the questionnaire, of whom 51 patients (76.1%) were employed within 3 years before surgery (mean age: 29.9 ± 11.8 years; mean follow-up: 54.6 ± 11.9 months) and had an average glenoid bone loss of 14.5 ± 6.1%. Fifty patients (98.0%) returned to work by 2.7 ± 3.0 months postoperatively; 45 patients (88.2%) patients returned to the same level of occupational intensity. Those who held sedentary, light, moderate, or heavy intensity occupations returned to their previous occupation at a rate of 100.0%, 93.3%, 90.0%, and 66.7% (P = .2) at a duration of 1.2 ± 1.6 months, 1.8 ± 1.9 months, 3.1 ± 3.5 months, and 6.5 ± 4.1 months (P = .001), respectively. The average postoperative Western Ontario Shoulder Instability Index score was 70.9 ± 34.2. Fifty patients (98.0%) noted at least “a little improvement” in their quality of life following surgery, with 35 patients (68.6%) noting great improvement. Furthermore, 49 patients (96.1%) reported being satisfied with their procedure, with 25 patients (49.0%) reporting being very satisfied. Four patients (7.8%) returned to the operating room, with 1 patient (2.0%) requiring arthroscopic shoulder stabilization.
Approximately 98% of patients who underwent Latarjet returned to work by 2.7 ± 3.0 months postoperatively. Patients with greater-intensity occupations had a longer duration of absence before returning to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
IV, case series.
Short-Term Clinical and Return-to-Work Outcomes After Arthroscopic Suprapectoral Onlay Biceps Tenodesis With a Single Suture Anchor
2021, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
Our findings suggest that although arthroscopic suprapectoral onlay single-anchor biceps tenodesis in conjunction with other common shoulder procedures may help provide overall reliable results for patients looking to return to occupational duties, the postoperative return among individuals with more intense physical demands may be prolonged and less predictable. It would be beneficial for surgeons to take this into account when counseling heavy-duty laborers preoperatively because fulfillment of preoperative expectations has been significantly linked with postoperative patient satisfaction.30-34 In recent systematic reviews by Abraham et al.35 and Hurley et al.,36 the authors showed that arthroscopic biceps tenodesis could lead to significant improvements in validated outcome scores (ASES, Simple Shoulder Test, VAS, and Disabilities of the Arm, Shoulder and Hand scores) and clinical ROM postoperatively, with results comparable to those of open techniques.
To describe short-term outcomes of arthroscopic suprapectoral onlay biceps tenodesis using a single all-suture anchor with respect to validated outcome measures, return to work, objective strength and motion data, and biceps-specific testing.
This study describes a consecutive series of patients undergoing arthroscopic suprapectoral onlay biceps tenodesis performed by a single surgeon from January to December 2017. Patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Surgeons questionnaire, visual analog scale, Single Assessment Numeric Evaluation, Veterans RAND 12-Item Health Survey, and 12-Item Short Form survey, and return-to-work survey. Postoperative strength, range of motion, and biceps-specific testing was also performed.
This study included 50 patients (26 men and 24 women), with an average age (± standard deviation) of 50.1 ± 10.9 years and average final follow-up of 21.3 ± 8.5 months. Among employed patients, 32 (71.1%) returned to work at an average of 4.6 ± 2.3 months. Light-duty workers returned to work at a significantly greater rate (85.7% vs 33.3%, P = .016) and in less time (2.6 ± 2.0 months vs 6.8 ± 4.2 months) than heavy-duty workers. No differences were found between operative and nonoperative sides in the biceps apex distance (P = .636) or range of motion in elbow flexion and extension (P > .9 for both), supination (P = .192), or pronation (P = .343) postoperatively. Strength in elbow flexion (P = .002), as well as shoulder forward elevation (P < .001) and external rotation (P < .001), increased postoperatively. Significant patient-reported improvements were noted in the American Shoulder and Elbow Surgeons score, visual analog scale pain score, Single Assessment Numeric Evaluation score, Constant-Murley score, and Veterans RAND 12-Item Health Survey and 12-Item Short Form physical component scores (P ≤ .001 for all). A postoperative Popeye deformity developed in 5 patients (10%).
Arthroscopic suprapectoral onlay biceps tenodesis with a single all-suture anchor can provide overall excellent clinical outcomes regarding strength, motion, and validated patient-reported outcome questionnaires. Return to occupational activities may be less predictable and more prolonged for heavy laborers. A small number of patients may experience cosmetic deformity postoperatively.
Level IV, therapeutic case series.
Influence of mental health on postoperative outcomes in patients following biceps tenodesis
2020, Journal of Shoulder and Elbow Surgery
To evaluate the relationship between preoperative mental health measured by the Short-Form 12 health survey mental component score and outcomes after isolated biceps tenodesis.
The American Shoulder and Elbow Surgeons form (ASES), Single Assessment Numeric Evaluation (SANE), Constant-Murley score (CMS), and visual analog scale (VAS) for pain were administered preoperatively and at 6 and 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018. Minimal clinically important difference, substantial clinical benefit (SCB), patient-acceptable symptom state (PASS), and rates of achievement were calculated. Patients were stratified by mental health status based on preoperative scores on the Short-Form 12 health survey mental component score. Multivariate logistic regression was performed to evaluate preoperative mental health status on achievement of minimal clinically important difference, SCB, and PASS.
Patients demonstrated significant improvements in all outcome measures (P < .001). Patients with depression reported inferior postoperative scores on all patient-reported outcome measures. Low preoperative mental health score significantly predicted reduced likelihood to achieve SCB (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.17-0.81, P = .01) and PASS (OR: 0.28, 95% CI: 0.12-0.65, P = .003) on the ASES form, SANE (OR: 0.24, 95% CI: 0.10-0.61, P = .003), CMS (OR: 0.25, 95% CI: 0.08-0.77, P = .016), and VAS pain (OR: 0.01, 95% CI: 0.00-0.31, P = .008).
Patients with depression reported inferior scores on all postoperative patient-reported outcome measures and demonstrated lower odds of achieving the SCB and PASS on the ASES form and PASS on the SANE, CMS, and VAS pain, compared with nondepressed patients.

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: The authors report the following potential conflicts of interest or sources of funding: B.J.C. receives support from Aesculap/B. Braun, American Journal of Orthopedics, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthrex, Arthroscopy, Arthroscopy Association of North America, Athletico, Carticept, DJ Orthopaedics, Elsevier Publishing, International Cartilage Repair Society, Journal of Bone & Joint Surgery—American, Journal of Shoulder and Elbow Surgery, Journal of the American Academy of Orthopaedic Surgeons, Medipost, National Institutes of Health (NIAMS & NICHD), Ossur, Regentis, Saunders/Mosby-Elsevier, Smith & Nephew, and Tornier.

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Level V EvidencePatient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management

Abstract

Section snippets

Introduction: Association Between Patient Understanding, Expectations, and Satisfaction

Patient Education: Rotator Cuff Injuries and Surgical Management

Patient Expectations and Concerns for Rotator Cuff Surgery

Factors Influencing Patient Satisfaction With Rotator Cuff Surgery

Discussion

Conclusions

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Mayo Clin Proc

J Arthroplasty

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Acta Orthop

Patient satisfaction: Implications and predictors of success

J Bone Joint Surg Am

What patients want: A content analysis of key qualities that influence patient satisfaction

J Med Pract Manage

Patients' misunderstanding of common orthopaedic terminology: The need for clarity

Ann R Coll Surg Engl

Patient-reported outcomes: Pathways to better health, better services, and better societies

Qual Life Res

Level V Evidence
Patient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management