‘Significant percentage’ of patients would not repeat routine hand procedures
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A significant percentage of patients would choose not to repeat surgery after undergoing routine hand procedures, according to published results.
“Outcomes for routine hand procedures, such as carpal tunnel and trigger finger releases, are typically presented to patients as ‘highly successful’ with ‘infrequent complications,’” Justin P. Chan, MD, of the department of orthopedic surgery at the University of California, Irvine, told Healio. “Our study found that a significant percentage of postoperative patients who underwent routine hand procedures, if given the chance to go back, would not choose to have surgery again.”
Using a prospective, hand surgery registry, Chan and colleagues collected the likelihood to repeat surgery at 12, 24 or 52 weeks postoperatively in patients undergoing nine common hand surgery procedures. Researchers analyzed the percentage of patients that would repeat the procedure for all diagnoses and stratified the overall proportion of patients who would repeat surgery by common hand surgery procedures.
Among 1,905 patients included in the analysis, results showed 81.6% of patients reported they would repeat surgery across all procedures. Researchers found a significant association between procedure and patient willingness to repeat surgery, with a significantly higher willingness to repeat surgery for carpal tunnel release, trigger finger release, and distal radius open reduction and internal fixation compared with satisfaction rates for ulnar nerve surgery at the elbow, basal joint arthroplasty procedures, and metacarpal and phalanx fractures. Researchers noted the percentage of patients that would repeat surgery ranged from 51.9% to 87.5% when stratified by the nine most common diagnoses.
“Hand surgeons can and should do better in setting clear and realistic preoperative expectations when counseling patients prior to even routine hand surgeries,” Chan said. “As patient satisfaction becomes an increasingly scrutinized metric for measuring quality in health care, being able to quantify and understand the determinants of satisfaction becomes even more important for orthopedic surgeons.”
Perspective
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The measurement of health care quality has become increasingly important. Satisfaction rates after hand surgery procedures have been published only sporadically. This paper takes a unique approach measuring patient satisfaction after hand surgery using one metric. They prospectively evaluated the patients’ likelihood to repeat their surgery.
I found the results enlightening. Simple procedures, commonly thought to have the highest satisfaction rates, such as carpal tunnel release (endoscopic and open), trigger finger release and ganglion cyst excision, had only a 75% to 88% willingness to repeat the procedure. On average for all of the studied procedures, only 81.6% patients would repeat surgery (range, 52% to 88%). The lowest rated procedure was ulnar nerve surgery at the elbow (52%).
It was eye opening that these routine, relatively low risk, high success procedures had such variable results. Patients often have unreasonable expectations, which can lead to dissatisfaction postoperatively. I think this paper is important as it emphasizes the importance of presurgery education and discussing with patients what can be expected after surgery, even with the “simplest” procedures we perform.
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