Predicting Long Term Outcomes at 6 Weeks with PRO’s

Predicting Long Term Outcomes at 6 Weeks with PRO’s

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Hypothesis:  Despite ongoing technical advances, many patients remain dissatisfied after upper extremity surgery.  A number of studies have attempted to identify risk factors for dissatisfaction using patient demographics, comorbidities, or diagnostic criteria.  This study utilized a novel approach of examining hand surgery registry data to predict patient dissatisfaction at 1 year based on the early post-operative QDASH trajectory.

Methods:  An on-going prospective hand surgery database among US-based surgeons was queried for patients responding to the question “Would you repeat surgery?” at post-operative time points of 3, 6, 12, 24, and 52 weeks.  The following responses were considered to be separate satisfaction tiers:  definitely not, probably not, unsure, yes-most likely, and yes-definitely.  Results were graphed against mean QDASH scores for each time point resulting in a recovery curve for each satisfaction tier.  Recovery curve slopes were calculated for 3 and 6 weeks to predict overall patient satisfaction.

Results:  All patient satisfaction tiers had statistically similar initial QDASH scores of 41.2-47.9 (range 0-100).  At 52 weeks there was a significant stratification amongst satisfaction groups ranging from 8.9 to 64.0 (Table 1).  We found that the recovery trajectory at 3 and 6 weeks were predictive of 1-year satisfaction tier.  At 6 weeks, the reduction in QDASH scores from “definitely not” to “yes-definitely” were -1.6, 3.2, 5.7, 15.6, and 26.2, respectively (Figure 1).

Summary Points:  Patient satisfaction, defined as the likelihood of repeating surgery at 1 year, correlates with a patient’s recovery trajectory only 6 weeks after surgery.  By regularly monitoring post-operative recovery trajectories, surgeons and staff can potentially intervene and change the recovery course for patients at risk of being dissatisfied with their procedure.  This study serves as a basis for future studies to further explore this relationship, its causes, and the effect of subsequent post-operative interventions.

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