Determinants of patient satisfaction after severe lower-extremity injuries.
BACKGROUND
In health care, increased emphasis has been placed on patient-centered care, but to our knowledge little work has been conducted to understand the influences on patient satisfaction after surgery for the treatment of severe lower-extremity injury. Our purpose was to analyze how the patient's satisfaction with the outcome correlates with other measures of outcome (clinical, functional, physical impairment, psychological impairment, and pain) and with the sociodemographic characteristics of the patient, the nature of the injury, and the treatment decisions.


METHODS
Four hundred and sixty-three patients treated for limb-threatening lower-extremity injuries at eight level-I trauma centers were followed prospectively. Multivariate regression techniques were used to identify factors correlating with variation in patient self-reported satisfaction at two years after the injury. The outcomes that were tested in the model were pain, range of motion, muscle strength, self-selected walking speed, depression, anxiety, the physical and psychosocial scores of the Sickness Impact Profile (SIP), return to work, and the number of major complications. The patient characteristics that were tested in the model were age, sex, education, poverty status, insurance status, occupation, race, personality profile, and medical comorbidities. Injury severity was tested in the model with use of both the Injury Severity Score and a score reflecting the probability of amputation. The treatment decisions that were tested were amputation versus reconstruction and time to treatment.


RESULTS
No patient demographic, treatment, or injury characteristics were found to correlate with patient satisfaction. Only measures of physical function, psychological distress, clinical recovery, and return to work correlated with patient satisfaction at two years. Five of these outcome measures accounted for >35% of the overall variation in patient satisfaction; these were return to work (p < 0.05), depression (p < 0.05), the physical functioning component of the SIP (p < 0.01), self-selected walking speed (p < 0.001), and pain intensity (p < 0.001). The absence of major complications and less anxiety were marginally significant (p < 0.1).


CONCLUSIONS
Patient satisfaction after surgical treatment of lower-extremity injury is predicted more by function, pain, and the presence of depression at two years than by any underlying characteristic of the patient, injury, or treatment.
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, T3R62, Baltimore, MD 21201, USA. rvo3@yahoo.com
Robert V
RV
O'Toole
Renan C
RC
Castillo
Andrew N
AN
Pollak
Ellen J
EJ
MacKenzie
Michael J
MJ
Bosse
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012044:Regression Analysis; D014947:Wounds and Injuries / Q000628:therapy*