What's a Successful Surgery? Hospital for Special Surgery Survey Shows Patients and Doctors Expectations Differ

NEW YORK -- Patients and their doctors often differ on what constitutes a successful surgery according to a recent survey at the Hospital for Special Surgery. To insure that patients are satisfied with their surgical results, doctors at Hospital for Special Surgery (HSS) recently surveyed 100 patients coming in for shoulder repair about their expectations. After reviewing the results, doctors realized what they define as successful surgery may not match their patients' expectations. Since pain relief seems like the obvious goal, doctors tend to assume they know what their patients want. However, the study found that while pain relief is an important goal, it is not the only one that patients use to measure the success of their surgeries. The study, which appeared in the Journal of Shoulder and Elbow Surgery published in the December 2002 issue, found that patients often consider other types of physical improvements just as important if not more so.

Patients were asked how they felt the surgical procedure would affect them both physically and psychologically. Through the 17 question survey doctors learned that not only did 75 percent of patients expect relief of all daytime pain and 85 percent expect relief of all nighttime pain but more important, 87 percent expected to be able to return to their lives as they were before this problem began. Specifically, 77 percent expected improvement in their abilities to perform household chores and to participate in recreational activities like playing with their grandchildren; 74 percent expected to improve their abilities to participate in sports and another 69 percent expected to improve their abilities to wash and dress themselves.

"If a patient is living pain free after a surgery many doctors would consider that a success. This survey clearly shows that may not be enough for a patient to determine the surgery a success. For example, if patients expect to return to certain activities at 100 percent and are only able to function at 60 to 70 percent, they may very well consider their surgery a failure. Therefore, it's important for me as a surgeon to know what it is that they expect to achieve by undergoing the surgery. You can't provide the best patient care if you don't understand the needs of the patient," said Dr. Edward Craig, attending orthopedic surgeon at Hospital for Special Surgery and past president of the American Shoulder and Elbow Surgeons.

The survey clearly shows that patients often make assumptions about their surgical recoveries that may be better or worse than what will actually occur. More important, it shows how important it is for patients and doctors to discuss expectations before undergoing surgery. While ambitious goals can often be reached, a misconception about what's realistic can leave a patient frustrated and dissatisfied. This survey is an important tool for patient- doctor dialogues about realistic and unrealistic goals.

Founded in 1863, the Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. Ranked No. 1 in the Northeast in its specialties by U.S. News and World Report's, HSS is the first New York City hospital to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. HSS is an academic teaching hospital affiliated with Weill Medical College-Cornell University. Its Research Institute is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. The hospital is located in New York City.

Patients should talk to their doctors about their surgery and what they should expect upon recovery. Often a discussion about what to expect can help calm any fears. Some questions patients should ask their doctor include:

* How many of these procedures have you and your hospital performed? Not

all doctors are the same. So when you see a specialist, you should ask

how many similar procedures your surgeon and the hospital have

performed. The more procedures your surgeon has performed, the more

comfortable and knowledgeable you should be.

* What are the risks involved? There is a natural fear that comes with

surgery. While most surgeries may seem routine to the physician, as a

patient you have the right to know what could possibly go wrong and how

often problems do arise.

* What are my options? Often a patient may not think to ask what other

forms of treatment are available. While it is wise to trust your

doctor's advice, it is always best to discuss all available options. You

may even be able to avoid surgery, if you are willing to commit to an

aggressive rehabilitation program.

* Will I be able to (fill in the blank)? If you have specific tasks you

want to be able to accomplish after surgery, you should talk to your

doctor about them. The last thing you want is to undergo surgery and be

disappointed with the outcome.

* Could the condition return? Surgery should repair your injury and leave

you pain free. However, a patient often requires surgery because of

simple "overuse" injuries associated with life's daily chores. Talk to

your doctor about what caused your injury and the likelihood of it

reoccurring.

* How long should I expect to be in the hospital? While some surgeries are

outpatient procedures, most are not. Upon leaving the hospital, make

sure you know what you will need to do to insure for proper care at

home.

* How long will the rehab process take? After surgery you need to

strengthen the muscles and tendons affected by the operation. How

aggressive and committed you are to your rehab program will have a

direct impact on how quickly you recover.

Source: Hospital for Special Survey