Patient expectations and patient-reported outcomes in surgery: a systematic review.
BACKGROUND
Recent events in health care reform have brought national attention to integrating patient experiences and expectations into quality metrics. Few studies have comprehensively evaluated the effect of patient expectations on patient-reported outcomes (PROs) after surgery. The purpose of this study is to systematically review the available literature describing the relationship between patient expectations and postoperative PROs.


METHODS
We performed a search of the literature published before November 1, 2012. Articles were included in the review if (1) primary data were presented, (2) patient expectations regarding a surgical procedure were measured, (3) PROs were measured, and (4) the relationship between patient expectations and PROs was specifically examined. PROs were categorized into 5 subgroups: Satisfaction, quality of life (QOL), disability, mood disorder, and pain. We examined each study to determine the relationship between patient expectations and PROs as well as study quality.


RESULTS
From the initial literature search yielding 1,708 studies, 60 articles were included. Fulfillment of expectations was associated with improved PROs among 24 studies. Positive expectations were correlated with improved PROs for 28 studies (47%), and poorer PROs for 9 studies (15%). Eighteen studies reported that fulfillment of expectations was correlated with improved patient satisfaction, and 10 studies identified that positive expectations were correlated with improved postoperative. Finally, patients with positive preoperative expectations reported less pain (8 studies) and disability (15 studies) compared with patients with negative preoperative expectations.


CONCLUSIONS
Patient expectations are inconsistently correlated with PROs after surgery, and there is no accepted method to capture perioperative expectations. Future efforts to rigorously measure expectations and explore their influence on postoperative outcomes can inform clinicians and policymakers seeking to integrate PROs into measures of surgical quality.
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.
Jennifer
J
Waljee
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.
Evan P
EP
McGlinn
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.
Erika Davis
ED
Sears
Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI. Electronic address: kecchung@umich.edu.
Kevin C
KC
Chung
D006801:Humans; D019964:Mood Disorders / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D013514:Surgical Procedures, Operative / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome