Predicting Patient Dissatisfaction Following Joint Replacement Surgery

Objective. The incidence of patient-reported dissatisfaction following total joint arthroplasty can be up to 30%. Our aim was to identify the preoperative patient-level predictors of patient dissatisfaction 1 year after surgery. Methods. We surveyed 1720 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, comorbidities, and education were recorded. Joint functional status and patient quality of life were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Study Short Form-36 (SF-36) scales, respectively. Patient satisfaction with surgery was determined with 4 survey questions at 1-year followup. Results. There were no significant differences in demographic data between satisfied (n = 1290) and dissatisfied patients (n = 430). Logistic regression modeling showed that a lower preoperative SF-36 Mental Health score independently predicted patient dissatisfaction with surgery, adjusted for all relevant covariates (p < 0.05). We found no correlation between patient satisfaction and WOMAC change scores at 1-year followup (p = 0.31). Conclusion. Preoperative mental health is an important factor to consider when understanding patient satisfaction with surgery. Interventions to reduce psychological distress prior to surgery should be studied to determine if they may improve subjective outcomes of patients undergoing joint replacement surgery. (First Release Nov 1 2008; J Rheumatol 2008;35:2415-8; doi:10.3899/ jrheum.080295)