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Predicting Likelihood to Repeat Elective Hand Surgery with Early Quick Disabilities of the Arm, Shoulder and Hand
Daniel A London1, Avery M Schroeder1, Justin P Chan2
1Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
Purpose:
Patient-reported outcome measures (PROMs) are collected after treatment to assess patient improvement. We sought to determine the postoperative timepoint at which changes in PROMs would best predict patients' likelihood to repeat surgery and offer clinically relevant information.
Methods:
Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected during the course of care of 883 patients before undergoing elective outpatient hand surgery and at 5 postoperative timepoints. Likelihood to repeat surgery was collected 1 year after surgery, and patients were dichotomized into likely and unlikely to repeat surgery groups. Differences in the change in QuickDASH scores between groups were compared using Mann-Whitney U tests. Receiver operating characteristic curves were used in conjunction with Youden's index to determine the timepoints and cutoff levels at which likelihood to repeat surgery could be successfully predicted.
Results:
In our cohort of 883 patients, 88.3% of patients indicated 1 year after surgery that they would be willing to repeat surgery. Receiver operating characteristic analyses demonstrated that changes in QuickDASH scores at 3, 12, 24, and 52 weeks were all significantly associated with patient likelihood to repeat surgery. A change in QuickDASH score of 10.0 three weeks after surgery was the ideal cutoff point to identify an association of patient likelihood to repeat elective hand surgery 1 year after surgery.
Conclusions:
Changes in QuickDASH scores as early as 3 weeks after surgery were associated with patient likelihood to repeat elective hand surgery 1 year after surgery. Although the heterogeneity of procedures included in the analyzed data pool precludes the complete generalizability of these findings to current clinical practice, it does support a feasible utility for early PROM collection in predicting patient satisfaction with their surgical outcome. This finding supports the continued, focused study of early PROMs, with potential for their employment in various clinical applications including real-time analysis for early postoperative intervention.
Type Of Study/Level Of Evidence:
Therapeutic IIIb.
