Patients' Expectations for Surgery Affect OutcomeThe goal of orthopedic surgery, repairs and replacements, is to minimize or eliminate pain and to help patients regain the use of the affected limb. Researchers in earlier studies have looked at how successful knee and hip surgeries are in relation to the patients' expected outcome. They found if a patient expects the surgery to be successful, the chances of the success are higher than if the patient was doubtful. No such studies have been found regarding rotator cuff repairs, or repair of the shoulder.
The authors of this study wanted to see if how the expectations of patients who were undergoing surgery to repair the rotator cuff would affect the outcome of the surgery. To do this, the researchers enrolled 125 patients who had symptoms of a rotator cuff tear for at least 3 months and they could not have had previous surgery. The patients ranged in age from 32 to 84 years; the average age was 56. The majority of the patients (72) were male and the length of time that the injury was present ranged from 3 months to 210 months.
Before the surgery, the patients were evaluated with a medical history, physical examination and questionnaires completed by the patients. The questionnaires included the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, visual analog scales (VAS) for shoulder pain and shoulder function, the Short Form-36 (SF-36, which evaluated overall health, and 6 questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire, which evaluated patient expectations.
Among the group, 26 patients had an open repair, the more traditional type of surgery, 62 had a mini-open repair, which involves a smaller than usual incision, and 37 had arthroscopic repair, which involves very small incisions to allow the surgeon to insert instruments with a camera to visualize what he or she is doing.
Following surgery, all patients used slings and went for physiotherapy to begin range-of-motion exercises the day after surgery. The patients were not to actively use their affected arm for 5 weeks.
When the patients were re-evaluated after the recovery period, the researchers found that the majority of the patients had high expectations regarding the success of the surgery and more than 85 percent felt that success was very likely or extremely likely. The majority of patients showed significant improvements on the various measurement scales. The better the expected outcome expressed before surgery resulted in better post-surgery performance, the researchers noted.
The authors conclude that the patients' expectation before surgery does affect their perception of the surgery's success. They do point out that the study has some weaknesses, foremost the possible differences in the tendons themselves, the actual surgery, and even the surgeon's approach to the surgery.
R. Frank Henn III, MD, et al. Patients' Preoperative Expectations Predict the Outcome of Rotator Cuff Repair. In The Journal of Bone and Joint Surgery. September 2007. Vol. 89-A. No. 9. Pp. 1912-1919.
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