Surgeons and their patients disagree regarding cosmetic and overall outcomes after surgery for high-energy lower extremity trauma

Abstract

Objectives: To determine whether surgeons' and patients' perceptions of outcomes after high-energy lower-extremity trauma are similar and to identify factors associated with disagreement.

Design: Prospective study.

Setting: Eight level 1 trauma centers.

Patients: Four hundred sixty-three patients treated for limb-threatening lower extremity injuries and followed for 2 years.

Intervention: Information collected on patients and injuries, functional and clinical outcomes, and surgeons' and patients' assessments of satisfaction with cosmetic and overall recovery.

Main outcome measurements: Satisfaction ratings compared with weighted kappa statistics.

Results: We observed very poor agreement between surgeons' and patients' perceptions of cosmetic and overall outcomes. Surgeons and patients agreed on overall outcomes at a rate only 25% higher than expected by chance (kappa = 0.25; 95% confidence interval, 0.05-0.34). The level of disagreement was even higher for cosmetic outcomes as surgeons and patients agreed at a rate only 17% higher than expected by chance (kappa = 0.17; 95% confidence interval, 0.09-0.26). Surgeons were less likely than patients to be satisfied with overall recovery if the patient had an Injury Severity Score >17, had a complication, or failed to return to work at 1 year. Patients were less satisfied than surgeons with overall recovery when the patient was dissatisfied with the quality of medical care. Surgeons were less likely than patients to be satisfied with cosmetic recovery if the patient sustained a traumatic amputation or experienced a complication. Patients were less likely than surgeons to be satisfied with cosmetic recovery if the patient was female or was dissatisfied with his or her medical care.

Conclusions: Surgeons' perceptions of patients' cosmetic and overall outcomes differed significantly from those of patients. Agreement was significantly worse for certain subgroups of patients. Further study of this discordance might improve our understanding of patient dissatisfaction and allow development of a more patient-centered care process.