Bouncing Back and the Link to Surgical Satisfaction, Outcomes

To what extent does the ability to bounce back or recover from physical or psychological stress affect surgical satisfaction and outcomes? Probably a lot, one would think. New research, however, raises a number of important questions about the relevance of this ability to bounce back, otherwise known as “resilience.”

Researchers from Brigham and Women’s Hospital in Boston pulled together data from 175 people who underwent arthroscopic partial meniscectomy and/or chondroplasty and were preoperatively grouped into low-to-normal resilience or high resilience using the Brief Resilience Score (BRS).

Their work, “Resilience as a Predictor of Patient Satisfaction with Nonopioid Pain Management and Patient-Reported Outcome Measures After Knee Arthroscopy,” appears in the March 18, 2020 edition of Arthroscopy.

Co-author Elizabeth Matzkin, M.D., chief of Women’s Sports Medicine at Brigham and Women’s Hospital and an associate professor at Harvard Medical School, explained some of the origins of the study to OTW. “I had done a previous study looking at non-opioid postoperative pain management after knee arthroscopy. This study demonstrated that 81% of patients were satisfied with their post-operative pain management without narcotics. Many of the patients that were not satisfied had a history of previous narcotic usage. I wondered what other reasons may account for dissatisfaction with non-opioid pain management.”

Acknowledging a certain built-in resilience in her patients, Dr. Matzkin explained that, “Mostly all of my patients are seeing me to get back to sports/work or activity. I wondered if there would be differences in outcomes (PROMS [Patient Reported Outcome Measures]) or satisfaction with non-opioid pain management based on a patient’s resiliency—their ability as well as desire to get back to their activity. I started collecting the Brief Resiliency Score on all surgical patients. The BRS measures one’s ability to bounce back or recover from physical or psychological stress.”

“The results of this study demonstrated that in this cohort of patients, preoperative resilience score did not predict satisfaction with non-opioid pain management or post-operative outcomes.”

“These findings may be secondary to our small sample of patients of whom 66% were in the low/normal and 34% in the high resilience group. We were unable to look at low resilience alone because so few patients fell into this group.”

“One interesting finding that will require further investigation is that females had a slightly lower resilience score on average (63% as compared to 68% in their male counterparts). Future research might require stratification by sex and race to understand the utility of resilience scores in predicting postoperative outcomes and pain control.”

With COVID-19 not going anywhere soon, it is heartening to know that non-opioid medications fared well in this study.

“Most importantly,” said Dr. Matzkin, “in this study over 80% of patients were satisfied with their non-opioid postoperative knee arthroscopy pain management. This is important because as orthopedic surgeons we need to find ways to combat the current opioid epidemic.”

“Resilience may still play a role in pain management and outcome scores with larger or more painful procedures then knee arthroscopy. Also, larger more diverse patient populations with low, normal and high BRS scores need to be studied.”