87. PATIENT SATISFACTION AFTER TKR: WHO IS HAPPY AND WHO IS NOT?

Abstract

Purpose: The purpose of this study was to determine why some TKR patients are satisfied and others are dissatisfied.

Method: 2,481 primary TKR patients who had completed a decision date WOMAC were randomly identified within the Ontario Joint Replacement Registry (OJRR) database. One year post-operatively, these patients were mailed a survey to determine satisfaction/expectations, willingness to undergo surgery again, Jaeschke self-reported clinical improvement, WOMAC scores and complications. The satisfied and not satisfied patient groups were identified, statistical analysis employed to determine variables that individually affect satisfaction and logistic regression used to identify significant factors which might lead to patient dissatisfaction.

Results: Only 70% of primary TKR patients felt that their expectations had been met and 15% reported that they had no expectations. Only 81% of patients reported that they were satisfied with their TKR. When asked whether they would have their surgery again, 96% of the satisfied patients reported that they would do so as compared to only 63% in the dissatisfied group (p< 0.0001). Using the Jaeschke self-reported clinical improvement scale, 87% of TKR patients reported that they were improved, but only 75% reported that they were a good, great or a very great deal improved. There was a high correlation with the WOMAC change score and the Jaeschke self-reported improvement and willingness to undergo surgery again questions. Significant differences were found between the satisfied and dissatisfied TKR patients in terms of a pre-operative WOMAC score of < 20 (p< 0.004), the WOMAC change score (p< 0.0001), expectations (p< 0.0001), complications (p< 0.0001), age (p< 0.002), referral status (p< 0.0005), living alone (p< 0.01) and comorbidities (p< 0.05). Logistic regression suggested that the most important predictive factors were a pre-operative WOMAC < 20 (p< 004), the WOMAC change score (p< 0.0001), expectations met (p< 0.0001) and complications (p< 0.0001).

Conclusion: Only one in five primary TKR patients are satisfied with their operative procedure. Significant risk factors for patient dissatisfaction after primary TKR include a pre-operative WOMAC < 20, a WOMAC change score of less than 33 points, expectations that were not met or a complication.