Factors associated with satisfaction with bunion surgery in women

NewsBot · Aug 24, 2007

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Factors associated with satisfaction with bunion surgery in women: A prospective study
The Foot
Volume 17, Issue 3, September 2007, Pages 119-125

Background
Hallux valgus is a common indication for foot surgery. Over 25% of patients are dissatisfied with the outcome.

Objective
To examine women's pre- and post-surgical characteristics, regarding satisfaction with surgery for hallux valgus (‘bunions’).

Method
Prospective cohort of 95 consecutive female patients (132 ‘foot cases’) undergoing bunion surgery. Baseline interview and questionnaire asked about attitudes to fashion and footwear, plus SF-36 general health survey. At 12 months post-surgery, patients who were ‘very pleased’ with their surgery were compared with everyone else regarding their pre-, peri- and post-operative characteristics.

Results
By 12 months, key SF-36 domains had significantly improved. The 75 foot operations (n = 75/116, 64.7%) were associated with respondents being ‘very pleased’ with their foot surgery. Following adjustment, the odds of being ‘very pleased’ were severely reduced where respondents were not ‘very pleased’ their foot's appearance (p < 0.001), or where foot pain was anything but absent (p = 0.018). There was significant interaction between pre-operative expectations of resumption of hiking/sports activities and range of footwear able to be worn post-operatively.

Conclusions
The perceived appearance of their foot and range of shoes that women can wear, are crucial to womens’ satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important.
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DrPod · Aug 24, 2007

Conclusions
The perceived appearance of their foot and range of shoes that women can wear, are crucial to womens’ satisfaction with the outcome of bunion surgery. The (total) alleviation of pain is also important.
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Am I missing something here? Dont we already know this. Its not rocket science.

drsarbes · Aug 27, 2007

DrPod, I think you're right. I realized this while still in my residency.

You can add to the list that is paramount to success:
* A scar you can't see (under magnification!)
* No out of pocket expense.
I can also add a "return to work" issue - a full spectrum of time frame. Whether it is returning in one day or returning in five months, depending (of course) on the patient's wishes!

DrSArbes

NewsBot · Sep 26, 2018

Delayed access to bunion correction surgery
Are patient-reported outcomes affected?
Kevin Wing, MD, FRCSC, Jason Sutherland, MSc, PhD, Alastair Younger, MBChB, ChM, FRCSC, ...
Foot & Ankle Orthopaedics September 19, 2018

Introduction/Purpose:
Little is known about the effect of delayed access to bunion correction (Hallux Valgus) surgery on patient-reported outcomes. The objective of this study is to measure the association between delayed access to bunion correction surgery and post-operative patient-reported outcomes.

Methods:
This study prospectively recruited patients to complete pre-operative patient-reported outcomes measuring pain, depression and foot and ankle health. Patients complete the same patient-reported outcomes six months post-operatively. Linear regression models measured outcomes, adjusting for baseline health, age category, sex, comorbidities and socio-economic status.

Results:
This study included 74 participants, a response rate of 53% among eligible patients. Among participants, 58.9% underwent a Lapidus procedure, the remainder underwent a corrective osteotomy. There was no relationship between post-operative depression and pain scores with duration of wait time, adjusting for patient characteristics. Longer waits for bunion correction surgery, adjusting for other factors, were associated with smaller gains in health in four of the five domains of measurement of foot and ankle health.

Conclusion:
At the six-month post-operative time point, prolonged wait times were detrimental to foot and ankle outcomes in four of the five domains of the foot and ankle specific PRO. Policies for expediting access for symptomatic hallux valgus are warranted to mitigate poorer long-term outcomes.
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NewsBot · Nov 9, 2019

Role of Patient-Reported Outcome Measures on Predicting Outcome of Bunion Surgery
Ashlee MacDonald, MD, Jeff Houck, PT, PhD, Judith F. Baumhauer, MD, MPH
Foot & Ankle International November 8, 2019

Background:
Prior studies have suggested preoperative patient-reported outcome scores could predict patients who would achieve a clinically meaningful improvement with hallux valgus surgery. Our goal was to determine bunionectomy-specific thresholds using Patient-Reported Outcomes Measurement Information System (PROMIS) values to predict patients who would or would not benefit from bunion surgery.

Methods:
PROMIS physical function (PF), pain interference (PI), and depression assessments were prospectively collected. Forty-two patients were included in the study. Using preoperative and final follow-up visit scores, minimally clinically important differences (MCID), receiver operating characteristic (ROC) curves, and area under the curve (AUC) analyses were performed to determine if preoperative PROMIS scores predicted achieving MCID with 95% specificity or failing to achieve an MCID with 95% sensitivity.

Results:
PROMIS PF demonstrated a significant AUC and likelihood ratio. The preoperative threshold score for failing to achieve MCID for PF was 49.6 with 95% sensitivity. The likelihood ratio was 0.14 (confidence interval, 0.02-0.94). The posttest probability of failure to achieve an MCID for PF was 94.1%. PI and depression AUCs were not significant, and thus thresholds were not determined.

Conclusion:
We identified a PF threshold of 49.6, which was nearly 1 standard deviation higher than previously published. If a patient is hoping to improve PF, a patient with a preoperative t score >49.6 may not benefit from surgery. This study also suggests the need for additional research to delineate procedure-specific thresholds.
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NewsBot · Jul 1, 2021

Association of Visual Appearance on Outcomes After Hallux Valgus Surgery
Hakan Bahar, Kadir Ilker Yildiz
Foot Ankle Int. 2021 Jun 30;10711007211019940

Background: In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery.

Methods: Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles.

Results: There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022).

Conclusion: Visualizing improvement in the cosmetic appearance of the foot appears associated with patients' perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded.
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NewsBot · Nov 10, 2021

Pre-operative expectations versus reality: A patient experience study following scarf osteotomy for hallux valgus correction
Sohail Yousaf et al
October 29, 2021

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. Pre-operative hallux valgus patients usually represent a young population with high demands that desire a quick functional recovery. The primary objective of the study was to identify the most common patient ‘expectations’ from hallux valgus surgery and establish over what time period post-surgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (>18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre-and-post-operative MOxFQ and VAS scores. A separate ‘expectations’ questionnaire was designed and completed assessing the patient's pre-operative rehabilitation expectations compared to the actual time taken to achieve those goals. These included five domains: pain improvement; return to walking unaided; return to normal foot sensation; return to normal footwear and return to driving. The post-operative functional scores demonstrated statistically significant improvement post-surgery (P<.001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (P<.001) along with trends toward an earlier return to driving function of patient expectation (P<.05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weight bearing and return to function.
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NewsBot · Jan 5, 2022

Do patient personality traits and self-reported physical and psychosocial symptoms help to predict hallux valgus surgery outcomes?
Erin E Klein et al
December 18, 2021

As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery. Eighty consecutive adult patients (mean age 45 ± 14 yrs, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from Jan. 2016 to Jan. 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery. In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1–19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses. We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the US has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.
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NewsBot · May 12, 2022

Predictors of Patient Satisfaction in Hallux Valgus Surgery
Harish Thiyagarajan et al
May 04, 2022

This study aims to analyze a combination of pre-operative biodata, radiological parameters, and validated functional scores to determine predictors for patient satisfaction in patients who have undergone Hallux abducto valgus (HAV) surgery at 2 years post-operatively. Data from 288 patients who had undergone HAV surgery and 373 cases was collected between 2007–2013. The study group measured the HAV angle (HVA), tibial sesamoid position (TSP), as well as inter-metatarsal angle (IMA) on both pre and post-operative radiographs for all patients. Clinical outcomes such as the Visual Analogue Scale for pain, the AOFAS Hallux MTP-ITP Scale, and Short Form 36 Health Survey's physical and mental component scores (PCS and MCS) were captured pre-operatively and post-operatively too. Univariate analysis was performed first to determine possible predictors of patient satisfaction and the results were then included in a binary logistic regression model. Independent predictors of patient satisfaction include higher pre-operative AOFAS (P value = 0.028, 95% CI 0.958, 0.998) and the 2 years post-operative AOFAS (p=0.001, 95 % CI 1.027, 1.114). We also found PCS and MCS scores at 2 years post-operatively to be independent predictors of patient satisfaction (P=0.004, 95% CI 1.015, 1.086 and P = 0.045, 95% CI 1.001, 1.064 respectively) . Predictors of patient satisfaction include subjective outcomes such as the AOFAS score and the SF-36 composite quality of life scales of PCS and MCS, rather than objective radiological outcomes such as HVA, IMA, and TSP.
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drsarbes Well-Known Member

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