Impact of Discordant Patient-Surgeon Expectations on Joint Arthroplasty Outcomes

摘要 全关节置换术（TJA）的使用率急剧增加（ 1998-2005年）伴随着患者人口统计学特征的变化。TJA是 越来越多的年轻人和功能较弱的人使用， 对手术期望更高知道未满足的期望与 不满和潜在的低等功能，解决这些日益增长的期望 并且为手术设定现实的可实现的目标成为真实的挑战。而 外科医生的目标是通过与患者的讨论来引导期望， 患者同意手术的目标，他们对齐的程度， 这种不一致对结果有什么影响，以及在哪些患者亚群中， 仍然知之甚少。因此，拟议的研究将评估 对TJA即刻和长期功能结局的预期不一致。 本建议的指导阶段将评估这种现象在多大程度上 不和谐的存在及其相关因素。独立阶段将发展 预测模型，以检查这种不一致的影响，立即以及 短期和长期的结果。 本研究将使用来自特殊外科医院（HSS）CERT TJA登记研究的数据， 该组织成立于2007年，得到了AHRQ的支持， 8000多名患者。术前对受试者进行评估，并在6个月时进行随访 2年评估满意度和功能变化。预期将 术前使用经验证的HSS TJA预期调查进行测量。

Abstract The dramatic increase in utilization of total joint arthroplasty (TJA) (doubled between 1998-2005) has been accompanied by a change in patient's demographic profile. TJA is increasingly being utilized by younger and less functionally debilitated individuals who expect more from the surgery. Knowing that unmet expectations are associated with dissatisfaction and potentially inferior function, addressing these increasing expectations and setting realistically achievable goals for the surgery becomes a real challenge. While surgeons aim to guide expectations through discussions with their patients so surgeons and patients agree on the goals of surgery, the degree to which they are aligned and what impact that discordance has on outcomes and in which subpopulations of patients remains poorly understood. Therefore, the proposed research will evaluate the impact of discordance in expectations on TJA immediate and long-term functional outcomes. The mentored phase of this proposal will evaluate the degree to which the phenomenon of discordance exists and what its correlates are. The independent phase will develop predictive models to examine the effect of this discordance on immediate as well as short and long-term outcomes. This study will use data from the Hospital for Special Surgery (HSS) CERT TJA registry, which was established in 2007 with support from AHRQ and has thus far enrolled more than 8000 patients. Subjects are evaluated preoperatively and followed up at 6 months and 2 years to assess satisfaction and changes in function. Expectations will be measured preoperatively using the validated HSS TJA expectations surveys.