Complete fulfillment of expectations is associated with greater satisfaction after shoulder arthroplasty: results from a prospective multicenter cohort study

Background: With this study, we aim to explore pre-operative probabilistic expectations (what does the patient realistically expect) and value-based expectations (what does a patient consider important), post-operative expectation fulfillment, and the relationship with post-operative satisfaction in shoulder arthroplasty (SA) patients. We hypothesized that higher expectation fulfillment is related to higher post-operative satisfaction, corrected for baseline level of optimism. Methods: In this prospective multicenter cohort study, 230 SA patients were included. These patients completed pre-operative questionnaires measuring probabilistic (Sunnybrook questionnaire) and value-based expectations (Hospital for Special Surgery Shoulder Expectations questionnaire) as well as optimism (Life Orientation Test - Revised). Post-operatively, expectation fulfillment/improvement and post-operative satisfaction were measured. We used ordinal logistic regression to study whether expectation fulfillment is related to post-operative satisfaction, corrected for baseline level of optimism. Results: For pre-operative probabilistic expectations, patients expected improvement on a median of 5 domains (interquartile range 4-6) out of 6 possible domains. For pre-operative value-based expectations, patients had a median of 5 (interquartile range 3-9) out of 17 possible expectations that they valued as 'Very important'. At 6 months and 12 months, the median percentage of completely fulfilled probabilistic expectations per patient was 75% and 80%, respectively. The median percentage of completely improved 'very important' value-based expectations per patient was 7.7% and 14.3%. Patients with higher percentages of fulfilled or improved expectations had higher odds of being 'very satisfied' post-operatively. Conclusion: This study shows that fulfillment of probabilistic expectations and improvement on value-based expectations is associated with post-operative satisfaction after SA.