Factors that influence patients to have shoulder and elbow surgery

Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions.

This is an interesting study of the willingness of patients to consider elective shoulder or elbow surgery.

A greater perceived level of the likelihood of surgical success by the patient, greater fluency in the English language, and willingness to consider surgery before consultation were positive predictors of the patient's ultimate willingness to consider surgery.

The authors found that lower income, living alone, and concern about surgery being an inconvenience to daily life were negative predictors of willingness to consider surgery. The authors viewed these as "barriers to potentially beneficial surgical interventions".

We suggest that the critical question is not whether the patient is willing to have surgery, but rather a better question is whether surgery is appropriate for this patient. As surgeons we can vary our "pitch" so that surgery sounds more or less attractive to the patient. It seems to us each of the 'negative' predictors of willingness may actually be negative predictors of outcome. For example, see Risk factors for readmission of orthopaedic surgical patients which was a retrospective cohort study of 3264 orthopaedic surgical admissions during two fiscal years. The authors concluded that marital status, Medicaid insurance status, and race may indicate how a patient's social and economic resources can impact his or her risk of being readmitted to the hospital.

Maybe a patient's 'unwillingness' is an appropriate barrier that we should not try to talk him or her out of. Maybe a non-English speaking man without substantial means, living alone in a mountain cabin who is worried about the effect on his ability to get along is not a good candidate for a reverse total shoulder, even if he has bad rotator cuff tear arthropathy. Elective surgery is elective for appropriate candidates. See here.

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When is it the right time for a shoulder replacement for arthritis?

The question of 'When is the time right for a shoulder replacement?' comes up often. We discuss this in this link.

 The answer depends on many things, including the degree to which the quality of life of the individual is impaired by the shoulder condition, the condition of the muscles, tendons, bone and nerves around the shoulder, the expectations of the patient, the overall health of the individual, the individual's willingness to accept the risks of surgery, and the degree of comfort the individual has with the surgeon.

As the reader knows from earlier posts, we use the Simple Shoulder Test (SST) to enable the individual to characterize the comfort and function of the shoulder.  I recently summarized the SST scores of over 2800 of our patients at the point where they had decided to have a shoulder joint replacement for their arthritis. The average preoperative SST score was 3.9. The numbers of patients with each of the 12 possible SST scores is shown below. Basically, this graph shows that 62% of patients having joint replacement had preoperative SST scores of 4 or below; 30% had SST scores from 5-8; and 8% had scores from 9-12.

Importantly, shoulder joint replacement for arthritis is an elective procedure. Each individual considering joint replacement should seek a surgeon with substantial experience with that procedure and work with that surgeon in discussing the surgical options, the timing of the procedure, and how the risks of the procedure can be minimized.

Here are some important considerations before proceeding.

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Use the "Search the Blog" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including: shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.

See the countries from which our readers come on this post.