A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty

Diagnostic injections are predictive of similar improvements following total hip arthroplasty in patients with radiologically mild osteoarthritis

Aims

Intra-articular (IA) injections are a useful diagnostic tool in patients presenting with debilitating hip pain but radiologically mild osteoarthritis (OA). We aim to explore the clinical and patient-reported outcomes (PROs) associated with patients who have radiologically mild OA and undergo total hip arthroplasty (THA) after an IA injection.

Methods

Patients undergoing primary, elective THA at a single centre between January 2017 and December 2023 were identified. Only those patients who underwent an IA injection into the operative hip within one year of surgery were included. Patients were divided into two cohorts based on the severity of their OA: those with Kellgren-Lawrence (KL) grade I to II arthritis were classified as 'mild', whereas those with KL grade III to IV arthritis were classified as 'severe'. Clinical outcomes and PROs, including the Hip disability and Osteoarthritis Outcome score for Joint Replacement, the Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey Mental and Physical subscales were compared between cohorts.

Results

The final cohorts included 25 and 225 patients with radiologically mild and severe OA, respectively. There were no baseline differences in age, sex, or time between IA injection and THA between cohorts. There were no significant differences in the preoperative or postoperative PRO values between patients with mild or severe arthritis (all p > 0.05). There were no significant differences in the change in PRO scores from the preoperative to final follow-up, or the percentage of patients who achieved the minimal clinically important difference on any of the PROs between cohorts. There were also no significant differences in the studied complications between groups.

Conclusion

Patients with radiologically mild OA who feel relief of their hip pain following an IA injection report similar preoperative debility and postoperative improvements in PROs following THA compared with patients with radiologically severe OA.

Single assessment numeric evaluation score as a simplified measure of patient satisfaction following breast reconstruction

INTRODUCTION

Patient-reported outcome measures (PROMs) that can be efficiently employed after breast reconstruction are being investigated as an alternative to the validated Breast-Q survey to obtain valuable data without survey fatigue. The single assessment numeric evaluation (SANE) has been used to rate function after orthopedic surgery but has not been extrapolated to functional and aesthetic outcomes after breast reconstruction.

METHODS

Overall, 255 patients who underwent mastectomy and breast reconstruction from 2017 to 2020 were contacted to complete the SANE and Breast-Q Post-op Module for aesthetic and functional outcomes. Demographics, comorbidities, treatment, and surgical characteristics were reported, and Pearson Correlation between survey mechanisms was evaluated.

RESULTS

Overall, 91 patients completed both surveys with a mean aesthetic SANE score of 60.6 ± 28.0, and mean Aesthetic Breast-Q score of 61.4 ± 19.8 showing a significant positive correlation between the 2 surveys for aesthetic outcome (R = 0.76, P < 0.001). The mean function SANE score was 74.7 ± 26.4 and mean function Breast-Q was 74.0 ± 21.5, which also had a significant positive correlation (R = 0.532, P < 0.001). In unilateral cases, the SANE scores were consistently higher for the native breast than operated breast.

CONCLUSIONS

When applied to breast reconstruction, the SANE scoring tool correlated strongly with the validated Breast-Q for functional and aesthetic outcomes. This study demonstrates the feasibility of using the SANE score outside the field of orthopedics. Future studies will focus on the application of this efficient PROM to a larger patient population in a longitudinal setting to evaluate its performance as a repeated measure.

Denervation procedure of the lateral epicondyle for refractory lateral epicondylitis

Background

Lateral epicondylitis is the most common cause of lateral elbow pain in adults, and nonoperative treatment is the first-line management modality of choice. Pain refractory to conservative management may improve with surgical interventions involving extensor carpi radialis brevis débridement or denervation. This investigation was conducted to evaluate the long-term analgesic efficacy, incidence of postoperative sensory deficits, and postoperative elbow functionality in patients who underwent a denervation surgery of the posterior branch of the posterior cutaneous nerve of the forearm (PBPCNF) for refractory lateral epicondylitis.

Methods

This investigation was an institutional review board-approved, single-center, single-surgeon case series of 22 patients who underwent denervation surgery with an average final follow-up of 4.7 years. Inclusion criteria for surgery were a minimum of 6 months symptom duration refractory to conservative therapies, a minimum of 2 years clinical follow-up, and significant (70-80%) pain relief from the nerve block test. Visual Analog Scale pain and Single Assessment Numeric Evaluation scores were used to assess pain and function, respectively. The incidence of postoperative sensory deficits was evaluated via clinical exam.

Results

Compared to the preoperative average, the cohort's mean Visual Analog Scale pain was significantly decreased at all postoperative follow-up intervals, including 2 weeks, 1 year, and final average follow-up of 4.7 years. At the final follow-up, the mean Single Assessment Numeric Evaluation score was 98.8 ± 2.6, and one patient (4.5%), who reported the same sensory deficit preoperatively, reported postoperative sensory deficits.

Conclusion

The PBPCNF denervation procedure is a highly efficacious procedure for achieving long-term pain control in the treatment of refractory lateral epicondylitis. The PBPCNF denervation procedure affords patients a high level of postoperative functionality with a low incidence of sensory deficits.

Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures

Aims

The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain.

Methods

This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients.

Results

Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values.

Conclusion

This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.

The minimal important difference and smallest detectable change of the Oxford elbow score, Quick disabilities of the arm shoulder and hand and single assessment numeric evaluation used for elbow trauma

Background

The Minimal Important Difference (MID) and Smallest Detectable Change (SDC) are methods used to identify the smallest changes in Patient-Reported Outcome Measures (PROMs) that are of relevance to the patients. Data on these parameters is, however, limited for elbow conditions including traumatic injuries. The aim of this study was, therefore, to estimate the MID and SDC for three commonly used PROMs after elbow trauma; the Oxford Elbow Score (OES), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) and Single Assessment Numeric Evaluation (SANE).

Methods

One hundred patients, 67 females, aged ≥18 years (mean age 52.4 years (standard deviation, 18.2)), who had sustained a fracture, tendon rupture or dislocation affecting the elbow, completed the OES, QuickDASH, and SANE 3-5 months after injury (T1) and again after a minimum of 3 weeks (T2). A transition item with a 7-level scale, enquiring about the situation with the elbow, was also completed at T1 and T2. The difference in scores between T1 and T2 was calculated (change scores). The MID was assessed using the mean change method; a response of "slightly better" or "slightly worse" was defined as being a clinically significant change. The SDC was estimated by calculating the standard error of measurement based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1- 2 years previously.

Results

The most common diagnosis was fracture of the proximal radius (n = 33). Eighteen patients responded slightly better and 5 slightly worse on the transition item and had mean change scores of 7.9 (9.3) for the OES and -7.4 (11.4) for the QuickDASH. Assessment of SDC was based on 56 patients having sustained an elbow injury between September 2019 and October 2020. The SDC was: 12.1 for the OES, 11.4 for the QuickDASH, and 1.94 for the SANE.

Conclusion

Change scores need to exceed 12.1 points for the OES, 11.4 points for the QuickDASH, and 1.94 points for the SANE in order to measure change with clinical relevance and not due to measurement errors.

Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique

BACKGROUND

The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA.

METHODS

Prospectively collected Patient-Reported Outcomes Measurement Information System-10 (PROMIS) Global Mental Health (GMH) scores at preoperative baseline, and 1, 3, and 6 months after THA were accessed on 4,353 patients in the Pulmonary Embolism Prevention After HiP and KneE Replacement (PEPPER) Trial (ClinicalTrials.gov: NCT02810704). Anesthesia was categorized as: general (GA), neuraxial (NA), and neuraxial with peripheral block (NAP). The GMH was assessed longitudinally and compared between groups.

RESULTS

Postoperative GMH improved (P < .05) over preoperative in every anesthetic group. Groups receiving NA had higher baseline GMH scores. Improvement in GMH was diminished after GA alone and plateaued after 1 month. Adding NA or peripheral nerve block to GA conferred additional benefit to GMH improvement.

CONCLUSIONS

Patient-perceived mental health improves significantly after THA regardless of anesthetic type. Patients who have higher baseline GMH scores more commonly received NA, likely due to nonsurgical care determinants; these differences in mental wellness persisted at follow-up. Adjunctive NA or peripheral nerve block favored GMH improvement, whereas solitary GA diminished GMH improvement, which plateaued after 1 month. Substantial mental health benefits of THA may overshadow subtle differences in GMH attributable to anesthetic type.

Examining the Relationship Between Value and Patient Satisfaction With Treatment in Total Joint Arthroplasty

Background

A shift toward performance, cost, outcomes, and patient satisfaction has occurred with healthcare reform promoting value-based programs. The purpose of this study was to evaluate the relationship between patient satisfaction and value with treatment in a cohort of patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods

Value was determined by the relationship of treatment outcome with episodic cost. Measurements included both clinical outcomes and patient-reported outcomes. Participating surgeons took part in the modified Delphi method resulting in an algorithm measuring patient value. Treatment outcome, cost, and resultant value (outcome/cost) of both TKA and THA were evaluated using binomial logistic regression by adjusting for age, gender, body mass index, Charlson comorbidity index, tobacco, education, and income with patient-reported satisfaction as the outcome.

Results

This study had a total of 909 patients (TKA n = 438; THA n = 471), with an average age of 67 (TKA) and 65 (THA) years. Patient satisfaction shared a significant positive relationship with treatment outcome for TKA (odds ratio [OR] = 1.53, confidence interval [CI] = 1.35-1.73, P < .001) and THA (OR = 1.93, CI = 1.62-2.29, P < .001). Higher value was associated with a significantly higher odds of patient satisfaction for both TKA (OR = 1.39, CI = 1.25-1.54, P < .001) and THA (OR = 1.70, CI = 1.47-1.97, P < .001).

Conclusions

This study showed a positive relationship between treatment outcome but not cost with subsequent value and patient satisfaction. This method provides a promising approach to comprehensively evaluate outcomes, cost, and value of total joint arthroplasty procedures. This approach can help predict the probability of value-driven patient satisfaction.

Reliability, Measurement Error, Responsiveness, and Minimal Important Change of the Patient-Specific Functional Scale 2.0 for Patients With Nonspecific Neck Pain

OBJECTIVE

The Patient-Specific Functional Scale (PSFS) is a patient-reported outcome measure used to assess functional limitations. Recently, the PSFS 2.0 was proposed; this instrument includes an inverse numeric rating scale and an additional list of activities that patients can choose. The aim of this study was to assess the test-retest reliability, measurement error, responsiveness, and minimal important change of the PSFS 2.0 when used by patients with nonspecific neck pain.

METHODS

Patients with nonspecific neck pain completed a numeric rating scale, the PSFS 2.0, and the Neck Disability Index at baseline and again after 12 weeks. The Global Perceived Effect (GPE) was also collected at 12 weeks and used as an anchor. Test-retest measurement was assessed by completion of a second PSFS 2.0 after 1 week. Measurement error was calculated using a Bland-Altman plot. The receiver operating characteristic method with the anchor (GPE) functions as the reference standard was used for calculating the minimal important change.

RESULTS

One hundred patients were included, with 5 lost at follow-up. No floor and ceiling effects were reported. In the test-retest analysis, the mean difference was 0.15 (4.70 at first test and 4.50 at second test). The ICC (mixed models) was 0.95, indicating high agreement (95% CI = 0.92-0.97). For measurement error, the upper and lower limits of agreement were 0.95 and -1.25 points, respectively, with a smallest detectable change of 1.10. The minimal important change was determined to be 2.67 points. The PSFS 2.0 showed satisfactory responsiveness, with an area under the curve of 0.82 (95% CI = 0.70-0.93). There were substantial to high correlations between the change scores of the PSFS 2.0 and the Neck Disability Index and GPE (0.60 and 0.52, respectively; P < .001).

CONCLUSION

The PSFS 2.0 is a reliable and responsive patient-reported outcome measure for use by patients with neck pain.

Duration of rehabilitation therapy to achieve a minimal clinically important difference in mobility, walking endurance and patient-reported physical health: an observational study

OBJECTIVE

To compare the duration of exercise therapy needed to achieve a minimal clinically important difference in mobility, walking endurance and patient-reported global physical health in patients referred for inpatient rehabilitation after knee surgery, hip surgery, or with multiple sclerosis or Parkinson's disease.

DESIGN

Retrospective pre-post intervention observational cohort study.

SUBJECTS

A total of 388 patients (57% women, mean age 65.6 years (standard deviation 9.5)) with a minimum length of stay 10 days were included between 1 January 2020 and 30 April 2021.

METHODS

Outcomes were assessed at the start of, and discharge from, rehabilitation, using the following measures: mobility (Timed Up and Go test), walking endurance (6-minute walk test), patient-reported global physical health (Global Physical Health subscale of the 10-item Patient-Reported Outcomes Measurement Information System). The duration of exercise therapy needed to achieve a minimal clinically important difference was determined using anchor-based and distribution-based methods.

RESULTS

The duration of therapy needed to achieve a minimal clinically important difference was longer in patients with multiple sclerosis or Parkinson's disease (18-88 h) than in patients after knee or hip surgery (8-25 h). In all patient groups, the duration of exercise therapy needed, determined using the distribution-based method, was shortest for patient-reported global physical health (knee surgery 9.6 h, hip surgery 6.8 h, multiple sclerosis 38.7 h, Parkinson's disease 18.4 h).

CONCLUSION

The duration of active therapies required to achieve a minimal clinically important difference in physical outcomes varies widely (range 8-88 h) among different patient groups and outcomes.

The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period

Background

The Oxford Elbow Score (OES) is a well-validated, elbow-specific, patient-reported outcome measure (PROM), originally assigned a 4-week recall period. For PROMs, short recall periods could have some advantages, such as optimizing validity by minimizing the negative effects of inaccurate recollection and temporal trends (increase or decrease) in symptoms over the course of the recall period. Temporal trends in elbow function can, for example, be expected to occur over 4 weeks in patients recovering from an injury or surgery. The purpose of this study was to evaluate the measurement properties of the OES using a shortened, 7-day, recall period (OES-7d).

Methods

The inclusion criteria were fracture, tendon rupture or dislocation affecting the elbow, and age ≥18 years. Patients with Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores of ≥10 points preinjury (pre-existing upper extremity condition) or concurrent upper extremity injuries were excluded. Patients completed the OES-7d, QuickDASH, and Single Assessment Numeric Evaluation-Function for the last 7 days preinjury (T1), the first 7 days postinjury (T2) and a 7-day period 3-5 months postinjury (T3). Correlations were assessed with Spearman's rho. Analyses of construct validity (correlation between scores) and internal consistency (Cronbach's alpha) were based on T3 data. Responsiveness was assessed by correlating changes in scores (change scores) between time points. Intra-rater reliability was assessed by calculating intraclass correlation coefficients based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1-2 years previously.

Results

Seventy-five patients (45 women) were included between May 2020 and July 2021. Their mean age was 51.7 years. At T3, Spearman's rho was -0.91 for the correlation between OES total and QuickDASH scores and 0.76 for the correlation between OES total scores and Single Assessment Numeric Evaluation-Function values (construct validity). Spearman's rho for correlation between OES total and QuickDASH change scores from T2 to T3 (T3 minus T2) was -0.85 (responsiveness for improvement) and -0.88 for change scores from T1 to T2 (T2 minus T1, responsiveness for deterioration). For the OES domains, Cronbach's alpha was 0.83 for elbow function, 0.91 for pain and 0.90 for social-psychological domains. The intraclass correlation coefficient for the OES total score was 0.96.

Conclusion

The OES demonstrated good measurement properties when used with a 7-day recall period (OES-7d). These results further establish the OES as a well-validated, elbow-specific PROM and support using a 7-day recall period.

Single Assessment Numeric Evaluation Correlates with American Shoulder and Elbow Surgeons Score for Common Elbow Pathology: A Retrospective Cohort Study

BACKGROUND

There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single question assessment of the patient's perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature.

PURPOSE

To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons-Elbow score (ASES-E).

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 3.

METHODS

A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations (r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem.

RESULTS

A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E (r = 0.623; P < .001), with strongest correlation with the visual analog scale (VAS) (r = -0.518; P < .001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively (P < .001). Age (r = 0.027; P = .526), sex (r = 0.026; P = .555), VAS (r = -0.106; P = .013), and chronicity of the problem (r = -0.037; P = .384) were not found to be correlated with differences in ASES-E and SANE-E.

CONCLUSION

The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions.

The Single Assessment Numeric Evaluation (SANE) after anterior cervical discectomy and fusion: A pilot study

STUDY DESIGN

Retrospective cohort.

OBJECTIVES

To evaluate the single assessment numerical evaluation (SANE) as a patient reported outcomes measure (PROM) after anterior cervical discectomy and fusion (ACDF), by comparing to legacy measures.

METHODS

We included all patients undergoing ACDF with at least one year of follow up with complete PROM data. Patients completed the Neck Disability Index (NDI), the RAND-36 and the EuroQual Five Dimension (EQ-5D) scale, as well as the one-question SANE, pre- and post-operatively. Validity of SANE compared with other PROMs was determined utilizing Pearson's correlation (ρ), proportional bias (B), responsiveness, minimal clinically important difference (MCID) and agreement.

RESULTS

Sixty-nine patients were included. There were moderate-to-strong correlations at a minimum of one-year follow-up between the SANE and NDI (ρ = -0.73, P < 0.0001), RAND (ρ = 0.80, P < 0.0001), and EQ-5D (ρ = -0.66, P < 0.0001). No significant proportional bias was found for the SANE when compared to the RAND (B = 0.03, p = 0.99), NDI (B = -0.003, p = 0.99), or EQ-5D (B = -0.0007, p = 0.99). Responsiveness for SANE was statistically similar to all other PROMs. The MCID for SANE was determined to be 10.5, with 42% of patients achieving the MCID. Bland-Altman plots demonstrated high agreement between all PROMs.

CONCLUSION

We found the SANE score provides clinically important patient outcomes data after ACDF, despite only requiring answering one question. The SANE performs comparably to more burdensome health questionnaires. The SANE score may offer spine surgeons the option to easily and quickly collect clinically relevant data on their surgical patients.

Creating a Value Dashboard for Orthopaedic Surgical Procedures

BACKGROUND

Value-based health-care delivery is a framework for restructuring our health-care systems with the goal of providing better outcomes for patients at lower cost. Value is determined by patient health outcomes per dollar spent on health services. We sought to develop a value dashboard that could be used to easily track and improve the value of total hip and knee arthroplasty (THA and TKA).

METHODS

We created a value dashboard for TKAs and THAs at our institution. Value was defined as quality of outcomes per dollar spent. The dashboard for each procedure displayed the average value by surgeon, compared with institutional averages for physical function scores and cost. Quality metrics were determined by weighted surgeon ranking using a modified Delphi process and included both clinical and patient-reported outcomes, as measured by the mean change in the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) physical function score, mean change in the Hip disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) or the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), mean change in the modified Single Assessment Numeric Evaluation (SANE) score, complication rate, periprosthetic joint infection (PJI) rate, and 30-day readmission rate. Average direct costs per surgeon were used. Data from January 2017 through April 2018 were included to ensure 1-year follow-up.

RESULTS

Six surgeons were included in the value dashboard for TKA, and 5 were included in the THA dashboard. The value for TKA by surgeon ranged from 7% below to 12% above the institutional benchmark. The value for THA by surgeon ranged from 12% below to 7% above the institutional benchmark.

CONCLUSIONS

The proposed dashboard utilizes value in a health-care framework and could be used for comparing and improving value for THA and TKA. This dashboard successfully combined patient outcome metrics and direct costs of surgical procedures. Future studies should focus on involving patients in this process and using national data to create benchmarks, which could provide a more accurate representation of value than using institutional averages.

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

BACKGROUND

COVID-19 has caused unprecedented delays in elective orthopedic surgery. Understanding patients' perceptions of the disruptions in care and their willingness to reengage the healthcare system are crucial to planning the resumption of elective care.

QUESTIONS/PURPOSES

The purpose of this study was to elicit patient perceptions about delays in total joint arthroplasty during the COVID-19 pandemic.

METHODS

We identified a consecutive series of patients who experienced COVID-19-driven delays to scheduled total hip or knee arthroplasty at an urban, academic medical center in the Southeastern United States. A 20-item survey was administered via telephone. Answers were recorded and descriptive statistics were performed. A post hoc χ-square analysis compared characteristics and outlooks of patients who did and did not immediately desire surgery.

RESULTS

Of 111 patients (64% of those identified) who met inclusion criteria and completed the survey, 96% said they felt that they were treated fairly and 90% said that the surgical delay was in their best interest; 68% reported emotional distress from the delay, but 45% reported a desire to wait longer for the pandemic to subside. Lower joint-function scores, higher pain levels, higher pain catastrophizing scores, and longer latency from personally deciding to pursue surgery were associated with the reported need for immediate surgery.

CONCLUSION

Overall, patients reported that they understood the need for elective surgical delays during the COVID-19 pandemic. However, the psychological implications they reported were not negligible. Patient preference for immediate reengagement with the healthcare system was dichotomous, with many patients favoring precautionarily furthering the delay. Understanding these preferences will help optimize elective orthopedic care during unprecedented times.