Predicting Long Term Outcomes at 6 Weeks with PRO’s
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.