Foot and Ankle Patients Expect MORE Than Surgeons

Patients undergoing foot or ankle surgery have higher presurgical expectations than their surgeons, according to a new Hospital for Special Surgery study.

The researchers of the study, “Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery,” released as a part of the AAOS 2020 Virtual Education Experience, say this is an important finding because patient expectations of orthopedic procedures are strongly associated with clinical outcomes and postoperative satisfaction.

“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,” Hospital for Special Surgery (HSS) foot and ankle orthopedic surgeon and author of the study, Scott J. Ellis, M.D., said.

While the differences between patient and surgeon expectations have been explored in spine and total knee arthroplasty procedures, this is the first time for foot and ankle surgeries, according to HSS.

For the study, Dr. Ellis and his colleagues reviewed the operative schedules of seven foot and ankle surgeons at HSS and then teamed up with researchers from Weill Cornell Medicine, to administer a survey on expectations including those on pain, physical function and appearance to 202 patients and their surgeons.

The patients were also asked to complete Patient-Rated Outcomes Measurement Information System (PROMIS) tests on physical function, pain interference, pain intensity, depression, and global health before their surgeries.

“We determined that 66.3% of patients had higher expectations than their surgeons, 21.3% had concordant expectations, and 12.4% had lower expectations,” Dr. Ellis said. “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.”

“Although most surgeons do their best to engage in open conversations with their patients about what they can expect from surgery, many find it difficult to tell patients that they are not going to be as good as new postoperatively,” he added. “It is challenging to get patients past the belief that surgeons have a magic wand.”

The next steps for research on expectations of surgical patients should include medical literacy, patients’ knowledge of their condition and the bond between patient and surgeon, Dr. Ellis said.

“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.”