Wonder Why Patients Are Underwhelmed With FAIS Treatment?

When it comes to femoroacetabular impingement syndrome (FAIS), wondered a team of researchers from Israel, what is the relationship between preoperative expectations and the fulfillment of those expectations?

Their work, “Preoperative Expectations Do not Correlate With Postoperative iHOT-33 Scores and Patient Satisfaction Following Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome,” appears in the November 24, 2021 edition of Arthroscopy.

Co-author Shai Factor, M.D., an orthopedic surgery resident at Tel Aviv Medical Center told OTW, “As the literature on value-based medicine is ever-growing, it has become more apparent that patient satisfaction may play a significant role in postoperative outcomes. Satisfaction can be defined in several ways, one of which being as the relationship between preoperative expectations and the fulfillment of those expectations. The study was conducted after we collected and followed patients for at least two years from the surgery and we were able to perform the data analysis optimally.”

Preoperatively, patients completed the Hip Preservation Surgery Expectations Survey, as well as the preoperative and a minimum 2-year postoperative International Hip Outcome Tool-33. Patient information was gathered on gender, age, occupation, and body mass index, and at the last follow-up, patient satisfaction and postoperative complications were noted.

There were 69 patients included in the study, with a mean Hip Preservation Surgery Expectations Survey score of 83.8 ± 16.5. The mean Hip Preservation Surgery Expectations Survey-33 improved from 31.6 ± 15.8 preoperatively to 73 ± 25.9 postoperatively, and the mean patient satisfaction was 75.9 ± 26.9.

“The most important finding of this study,” Dr. Factor told OTW, “was that no correlation was found between preoperative expectations, postoperative iHOT-33 scores, and patient satisfaction. Gender and occupation did not differ significantly regarding preoperative expectations, and there was no correlation between age and Hip Preservation Surgery Expectations Survey score. Our hypothesis that higher preoperative expectations would result in greater improvements in iHOT- 33 and greater satisfaction was rejected.

Additional Lines of Inquiry, Potential Points of Intervention

“The results of the present study raise several unanswered questions, most important of which are the following: How can we test the patient’s understanding of the procedure to measure how realistic are their expectations? Where is the gap between the physician’s explanation of the procedure and patients’ understanding?”

“There is currently no strategy for preoperative interactions between the patient and the physician, and a uniform and structured tool that will help patients understand the procedure and its consequences is needed. Such a tool can be useful in identifying expectation disparities. Ultimately, matching patient expectations with the reality of a procedure may result in higher patient satisfaction. Future studies should focus on developing appropriate intervention tools that can be accompanied by questions that reveal the patients’ true understanding of the procedure.”