title: Patient Factors Associated With Higher Expectations From Foot and Ankle Surgery.
abstract: BACKGROUND
  Few authors have investigated patients' expectations from foot and ankle surgery. In this study, we aimed to examine relationships between patients' preoperative expectations and their demographic and clinical characteristics. We hypothesized that patients with more disability and those with anxiety or depressive symptoms would have greater expectations.
  
  
  METHODS
  All adult patients scheduled for elective foot or ankle surgery by 1 of 6 orthopaedic foot and ankle surgeons were screened for inclusion over 8 months. Preoperatively, all patients completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey in addition to the Foot & Ankle Outcome Score (FAOS), Short Form (SF)-12, Patient Health Questionnaire (PHQ)-8, Generalized Anxiety Disorder 7-item scale (GAD-7), and pain visual analog scale (VAS). The expectations survey contained 23 expectations categories, each with 5 answer choices ranging from "I do not have this expectation" to "complete improvement" expected. It was scored from 0 to 100, with higher scores indicating more expectations. Differences in expectations relating to numerous patient demographic and clinical variables were assessed. In total, 352 patients with an average age of 55 ± 15 (range, 18-86) years were enrolled.
  
  
  RESULTS
  Expectations scores were not related to age ( P = .36). On average, women expected to achieve complete improvement more often than men ( P = .011). Variables that were significantly associated with higher expectations scores ( P < .05) included nonwhite race, use of a cane or other assistive device, and greater medical comorbidity. Worse function and quality of life (as assessed by all FAOS subscales and the SF-12 physical and mental components), more depressive and anxiety symptoms, and higher pain VAS scores were associated with higher expectations scores and more expectations ( P < .01 for all).
  
  
  CONCLUSIONS
  The results of this study may help inform surgeons' preoperative discussions with their patients regarding realistic expectations from surgery. Generally, patients with worse function and more disability had higher expectations from surgery. Addressing these patients' expectations preoperatively may help improve their ultimate satisfaction with surgery.
  
  
  METHODS
  Level II, cross sectional study.
authors.affiliation: 1 Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cody
authors.affiliation: 2 Clinical Epidemiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.affiliation: 3 Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Jayme C
authors.initials: JC
authors.lastname: Burket
authors.affiliation: 4 Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Anca
authors.initials: A
authors.lastname: Marinescu
authors.affiliation: 5 Weill Cornell Medical College, New York, NY, USA.
authors.forename: Aoife
authors.initials: A
authors.lastname: MacMahon
authors.affiliation: 6 Hospital for Special Surgery, New York, NY, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
mesh_terms: D000842:Ankle / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D003430:Cross-Sectional Studies; D005528:Foot / Q000601:surgery*; D006801:Humans; D009985:Orthopedics; D010147:Pain Measurement; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: expectations; foot and ankle surgery; satisfaction