The role of patients’ overall expectations of health on outcomes following proximal humerus fracture repair - 31/08/21

Doi : 10.1016/j.otsr.2021.103043

Rebekah Belayneh ^a,^b,⁎ , Ariana Lott ^a, Jack Haglin ^a, Joseph Zuckerman ^a, Kenneth Egol ^a
^a Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17^th Street, 10003 New York, NY, USA
^b Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 911 L.S. Kaufmann Bldg., 15213 Pittsburgh, PA, USA

^⁎Corresponding author. UPMC Department of Orthopaedic Surgery, 3471 Fifth Avenue, 911 L.S. Kaufmann Bldg., 15213 Pittsburgh, PA, USA.UPMC Department of Orthopaedic Surgery3471 Fifth Avenue, 911 L.S. Kaufmann Bldg.Pittsburgh, PA15213USA

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Abstract

Introduction

The purpose of this study is to evaluate the relationship between patients’ own health expectations and treatment outcomes following surgical repair of proximal humerus fractures.

Hypothesis

Patients’ health expectations will correlate with treatment outcomes following surgical repair of proximal humerus fractures.

Material and methods

Over a 14-year period, 247 patients with a displaced proximal humerus fracture who underwent ORIF with locking compression plates were prospectively followed at one academic institution. Minimum follow-up period was 12 months. Patient-reported functional outcome data for the latest follow up visit (12 months and greater) was obtained from Disabilities of Arm, Shoulder, and Hand (DASH) questionnaires. Survey responses regarding health expectations were recorded at 3-month follow-up and converted to dichotomous variables. Two groups were identified: the high expectations and the low expectations groups. Statistical analysis comparing the two groups and their functional and clinical outcomes was performed using the independent t-test, using p<0.05 for significance. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to further statistically characterize the relationship between health expectations at 3 months and long-term outcomes.

Results

One hundred and eighty-five (75.0%) patients available for analysis with a mean follow-up length of 24.8 months. The cohort included 124 (67%) females and 61 (33%) males and the average age at time of injury was 59.5 years. Eighty-six (46.5%) patients had low expectations for their overall health and 99 (53.5%) patients had high expectations for their health. No significant differences were seen between groups in regards to age, gender, follow-up length, Charlson Comorbidity Index (CCI), smoking and tobacco use, fracture pattern (OTA and Neer classifications), early complications (p>0.05), fracture healing, and avascular necrosis. The mean DASH score at the latest follow up for patients with low expectations was 31.42±22.8 whereas the mean for those with high expectations was 16.76±20.2 (p<0.0005). The mean forward flexion of the shoulder for patients with low expectations was 137.8±31.5 degrees as compared to 148.5±26.3 degrees (p<0.05). The positive predictive value of good expectations correlating with good outcomes was 71.7%.

Discussion

Patients with high expectations for their health early following injury had better outcomes in the long term. These high expectations also appeared to have an optimal influence on range of shoulder motion. This data suggests attitudinal and psychological factors that affect patient health expectations early on in the course of treatment may also influence patients’ functional and clinical outcomes.