Complete fulfillment of expectations is associated with greater satisfaction after shoulder arthroplasty: results from a prospective multicenter cohort study

BackgroundWith this study, we aim to explore preoperative probabilistic expectations (what does the patient realistically expect) and value-based expectations (what does a patient consider important), postoperative expectation fulfillment and the relationship with postoperative satisfaction in shoulder arthroplasty (SA) patients.We hypothesized that higher expectation fulfillment is related to higher postoperative satisfaction, corrected for baseline level of optimism. MethodsIn this prospective multicenter cohort study, 230 SA patients were included.These patients completed preoperative questionnaires measuring probabilistic (Sunnybrook questionnaire) and value-based expectations (Hospital for Special Surgery Shoulder Expectations questionnaire) as well as optimism (Life Orientation Test -Revised).Postoperatively, expectation fulfillment/improvement and postoperative satisfaction were measured.We used ordinal logistic regression to study whether expectation fulfillment is related to postoperative satisfaction, corrected for baseline level of optimism. ResultsFor preoperative probabilistic expectations, patients expected improvement on a median of 5 domains (IQR 4 -6) out of six possible domains.For preoperative value-based expectations, patients had a median of 5 (IQR 3 -9) out of seventeen possible expectations that they valued as 'Very important'.At six months and twelve months, the median percentage of completely fulfilled probabilistic expectations per patient was 75% and 80%, respectively.The median percentage of completely improved 'very important' value-based expectations per patient was 7.7% and 14.3%.Patients with higher percentages of fulfilled or improved expectations had higher odds of being 'very satisfied' postoperatively. J o u r n a l P r e -p r o o f ConclusionsThis study shows that fulfillment of probabilistic expectations and improvement on value-based expectations is associated with postoperative satisfaction after shoulder arthroplasty.