Characterizing Preoperative Expectations for Patients Undergoing Reverse Total Shoulder Arthroplasty.

Abstract Background There remains a paucity of information analyzing which factors most influence preoperative expectations for patients undergoing reverse total shoulder arthroplasty (RTSA). The purpose of our study was to characterize preoperative patient expectations for those scheduled to undergo RTSA and to determine the impact of demographic factors, shoulder function, and shoulder pain on these preoperative expectations. Methods Patients were prospectively recruited into the study if they were scheduled to undergo an elective unilateral primary RTSA for a diagnosis of glenohumeral arthritis. Preoperative patient expectations were evaluated using the Hospital for Special Surgery’s Shoulder Surgery Expectation Survey (HSS-ES). Patients also completed the American Shoulder and Elbow Surgeons Shoulder Score, Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function – Upper Extremity (UE) v2.0 computer adaptive test, PROMIS Pain Interference (PI) v1.1 computer adaptive test, PROMIS Depression (DE) v1.0 computer adaptive test, visual analogue scores, and an itemized satisfaction questionnaire, which paralleled the HSS-ES. Demographic and preoperative shoulder range of motion (ROM) were also recorded. Results A total of 107 patients scheduled to undergo RTSA were included into the study. Relief of daytime pain (n = 91, 85%), improvement in self-care (n = 86, 80%), and improvement in shoulder ROM (n = 85, 79%) were most commonly cited as a “very important” expectation. In the item-specific analysis, lower PROMIS UE scores were correlated with greater expectations for ability to reach sideways (p = 0.015) and ability to perform daily activities (p = 0.018). Patients with lower shoulder ROM had greater expectations for improved shoulder ROM (internal rotation, arm at 90 degrees, p = 0.004) and improved ability to perform daily activities (forward elevation, p = 0.038; abduction, p = 0.009). In the cumulative analysis, a greater number of “very important” expectations was associated with African American race (p = 0.013), higher PROMIS PI (r = 0.351, p = 0.004), and lower overall preoperative satisfaction (r = 0.334, p Conclusion Patients scheduled to undergo RTSA have the greatest expectations for relief of daytime pain, improvement in self-care, and improvement in shoulder ROM. Patients with limited preoperative ROM have greater expectations for improvement in self-care and ability to perform daily activities in addition to expectations for improvement in shoulder ROM. Greater overall expectations for surgery were not associated with preoperative physical function, but were instead associated with lower preoperative satisfaction and higher PROMIS PI scores.