[csr86]

I have had failed ankle surgery and have read some research papers on the procedure that was done to me.

Often, the method was asessed by asking patients to score their situation before and after the surgery (e.g one year later).

For sure, many people try to be positive and give too optimistic scores. At least I felt it hard to admit that the costly procedure had failed and saying it to my surgeon didn't feel easy.

What I fear is, there are many research papers done using patient questionaire and giving us biased results

[spaetzleesser]

" At least I felt it hard to admit that the costly procedure had failed and saying it to my surgeon didn't feel easy."

That's one thing I have noticed. A few years ago my girlfriend had a failed surgery. She complained constantly during the weeks before the followup meeting. In the followup meeting the surgeon talked about how well the surgery had gone. My girlfriend basically agreed and they bantered around for almost half an hour. Ten minutes before the appointment ended I lost patience and said "Hold on, guys. This thing hasn't worked at all. The pain is worse than before and she talks at home about killing herself. How do we get out of this?". The surgeon gave me the evil eye, my girlfriend said nothing and we basically got kicked out soon.

It was a really weird dynamic. I wonder how many surgeries are scored as success because patients are afraid of telling the surgeon that it wasn't. I think it may be a substantial percentage where the hospital/surgeon never hears about problems and there is no independent follow up either.

[nickff]

Hospitals don't even track revision rates (the proportion of the time where a second surgery is required to 'fix' issues from the first), largely because some surgeons cause many problems, and don't want to see the numbers. It's a tragic state of affairs that leads to a great deal of suffering, and I am very pessimistic about the probability of meaningful reform.

[strstr]

Patient questionnaires with the right questions seem like the way to go.

When I was considering a Bankhart repair for my shoulder the number I looked at was return to sport. Sure, people can be biased about this, but this seems about as objective as you can get: “Are you able to participate in the activities you were able to before your injury?”

If you are getting a surgery without measurable outcomes, why are you getting this surgery at all?

[scsilver]

Thanks for that! I think thats a great indicator to note for the future.

[neolog]

What would be better than patient questionnaire?

[Scoundreller]

Functional assessment? Range of motion, strength, etc.

[jdmcnugent]

Speaking from an orthopedic perspective (though most fields are similar), there are literally thousands of ways to measure this, they are called (not surprisingly) outcome measures and they are basically the foundation of almost every medical study. Many are a collection of questions or items that add up to a given score which is how they are able to be statistically analyzed.

Some are subjective like pain (VAS or visual analog pain scale, “rate your pain 1-10”), ability to do daily activities, “would you have this procedure again?”, return to pre-injury activity level, etc.

Others are objective like range of motion, strength, bone healing noted on Xray or ct, tendon / ligament healing observed on mri, histiologic healing observed from follow up biopsy, rehospitilzation rates, revision surgery rates, infection rates, or mortality rates (the ultimate objective outcome measure).

There is hardly a shortage of outcome measures out there, and researchers propose new ones all the time, but they need to be validated as relevant and accurate by other studies before they are widely adopted.

http://www.orthopaedicscores.com

[csr86]

In some studies, they used things like positions and angles between bones (before and after surgery).

Unfortunately questionnaires might be only thing sometimes. My message is that, we should be more sceptical about them

[yourkin]

Technologies exist that give quantitative biomechanical analysis and "before" and "after" comparison, for example when fitting an orthesis or prosthesis.