Search

Background: Patient satisfaction metrics are commonly used to assess the quality of health care and affect reimbursement. The Press Ganey Ambulatory Surgery (PGAS) is a satisfaction survey that has emerged as a prominent quality assessment tool; however, no data exist on whether PGAS scores correlate with early postsurgical satisfaction during the PGAS survey administration period in patients who underwent anterior cruciate ligament reconstruction (ACLR). Purpose: To determine if PGAS scores correlate with measures of satisfaction and patient-reported outcomes (PROs) at 2 weeks postoperatively in ACLR patients. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review of patients who underwent ACLR at a single institution was performed. Patients who completed the PGAS survey and PROs at 2 weeks postoperatively were included in the study. Surgical satisfaction was measured with the Surgical Satisfaction Questionnaire (SSQ-8), and PROs included 6 Patient-Reported Outcomes Measurement Information System domains. Bivariate analysis between PGAS and PRO scores was conducted using the Spearman rank correlation coefficient (rS). Results: Of the 716 patients who received the PGAS survey after ACLR, 81 patients completed the survey, and 39 patients also completed PROs and were included in the study. Total converted (mean scaled score) and "top box" (percentages of questions with highest rating selected) PGAS scores showed no significant correlations with the SSQ-8 (rS =-0.24; P = .14). There were no significant correlations between SSQ-8 and PGAS domain scores except for a negative correlation with Facility domain top box scores (rS =-0.33; P = .04), meaning that patients with higher surgical satisfaction had lower PGAS Facility scores. Total PGAS (converted and top box scores) and PGAS domain scores showed no significant correlation with any of the other PROs. Conclusion: PGAS scores showed no significant positive correlation with surgical satisfaction, function, pain, mental health, activity, or expectations of surgery in patients 2 weeks after ACLR. This suggests little to no relationship between PGAS score and surgical satisfaction in the early recovery period after ACLR. [ABSTRACT FROM AUTHOR]

Background: Contextualizing patient-reported outcomes (PROs) by defining clinically relevant differences is important. Considering that anterior cruciate ligament reconstruction (ACLR) ideally results in the restoration of normal knee function, an assessment of patients' perception of being "completely better" (CB) may be of particular value. Purpose: The purpose of this study was to assess the prevalence and characteristics of patients who self-report a CB status after ACLR. Additionally, we aimed to determine whether PROs were associated with a CB status after ACLR as well as to determine CB status thresholds for 2-year and change in values. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively analyzed data from an orthopaedic registry at a single institution. Patients were administered the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), and International Knee Documentation Committee (IKDC) Subjective Knee Form preoperatively and at 2 years after ACLR. Additionally, patients completed a CB anchor question at 2 years after ACLR. Thresholds for 2-year and change in PRO scores associated with achieving a CB status were identified with 90% specificity. Results: Overall, 95 of the 136 patients (69.9%) considered their condition to be CB at 2 years after surgery. The 2-year and change in PROMIS PF, PROMIS PI, and IKDC scores were significantly better in the CB group than in the non-CB group. Thresholds associated with a CB status for 2-year PROMIS PF, PROMIS PI, and IKDC scores were more reliable than those for changes in scores and were ≥63, ≤44, and ≥80, respectively. Thresholds for the change in PROMIS PF, PROMIS PI, and IKDC scores were ≥19, ≤–16, and ≥44, respectively. Conclusion: The majority of patients reported that they were CB at 2 years after ACLR. This study may serve as a reference for orthopaedic surgeons and researchers when considering outcomes after ACLR. [ABSTRACT FROM AUTHOR]

Despite the increasing incidence of orthopaedic surgeries, there is a lack of data reporting on patient experience and recovery following surgery. As such, there is a need to better characterize the natural history of pain interference (PI) after orthopaedic surgery to better manage patients' expectations and recovery. To identify factors associated with greater pain interference two weeks following orthopaedic surgery. All patients undergoing elective outpatient orthopaedic surgery at a single urban academic institution were evaluated preoperatively from August 2016 to March 2018. Patients completed a baseline assessment consisting of demographic information, PROMIS computer adaptive testing in 6 domains including Pain Interference (PI), Physical Function, Social Satisfaction, Fatigue, Anxiety, and Depression. Two weeks following surgery, patients completed the same questionnaires along with assessments of Improvement and Satisfaction. Bivariate and multivariable regression analyses were performed. Categorical data was compared with ANOVA and continuous data was compared with Spearman's correlation coefficient (r s). 435 patients (age = 41.1 ± 15.7, 47% female) were studied. Mean PI was 60.1 ± 7.0 prior to surgery and 61.7 ± 7.6 at 2 weeks postoperative. Worse 2 week PROMIS PI was associated with lower extremity surgery, prior surgery on the joint, preoperative opioid use, depression, lower income, lower education, and higher ASA score (p < 0.05). Better 2 week PROMIS PI was correlated with better baseline and better 2 week scores on all outcome measures. Multivariable analysis demonstrated that lower extremity surgery, worse preoperative pain scores, and worse preoperative pain interference were independent predictors of worse pain interference after surgery. Early postoperative pain interference is associated with function, demographic, and psychosocial factors. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplant (MAT) is a salvage procedure for young patients with symptomatic meniscal deficiency. Although many studies report good outcomes, MAT remains controversial, and an optimal fixation technique for the meniscus roots is debated. Purpose: To assess the overall outcome of MAT and compare the results of different meniscal root fixation techniques. Study Design: Meta-analysis. Methods: Following specific guidelines, we systematically evaluated all current literature for studies reporting on the outcomes of patients who underwent MAT. Using random effect models of proportions, we determined the tear and failure rates. Standardized mean differences (SMDs) were calculated to determine the improvement in clinical outcomes and pain level. Data were then stratified by root fixation method into 2 groups: fixation that preserved the graft’s root insertions on the allograft bone (bone fixation group) and suture fixation of the root soft tissue without the allograft bone (soft tissue suture group). Results: A total of 38 studies (1637 MATs, 81% men) involving subjects with a mean age of 34 years (range, 20-48 years) and a mean follow-up of 60 months (range, 25-168 months) met inclusion criteria. This overall cohort had significant improvements in Lysholm scores (from 57.8 to 81.4 points; SMD 1.5, P < .001) and pain level (visual analog scale [VAS], from 56 to 21 points; SMD 1.8, P < .001). The cohort had a tear rate of 9% and a failure rate of 12.6%. No significant differences were found between the soft tissue suture (485 MATs) and bone fixation (489 MATs) groups in terms of meniscal allograft tear rates (13.4% vs 14.9%), failure rates (17.6% vs 18.8%), Lysholm scores (from 52.3 to 82.4, SMD 2.0, and from 60.7 to 82.9, SMD 1.7; respectively), and VAS scores (from 65 points to 18 points, SMD 2.6, and from 63 points to 13 points, SMD 3.1; both P < .001). Meniscal extrusion was similar, with a weighted mean percentage of extrusion of 40.2% in the soft tissue suture group and 43.1% in the bone fixation group. Conclusion: This meta-analysis demonstrated significant improvements in clinical outcomes for MAT patients with low tear and failure rates. The data do not demonstrate a difference between soft tissue suture and bone fixation for MAT root fixation. This suggests that the technique of root fixation may not have an appreciable influence on clinical outcome, pain reduction, extrusion, or MAT longevity. Further prospective trials are needed. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to identify patient characteristics and compartment pressure values in patients with chronic exertional compartment syndrome (CECS) that lead to improved postoperative outcomes. The results revealed that high school and college patients and isolated anterior compartment release were associated with improved subjective function and satisfaction after fasciotomy. High school and college patients had improved postoperative satisfaction.