Reaching MCID, SCB, and PASS for ASES, SANE, SST, and VAS following shoulder arthroplasty does not correlate with patient satisfaction

Background

Minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have been established in the literature to gauge shoulder arthroplasty treatment effectiveness. These metrics are established based on anchoring questions that do not account for a patient’s satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Simple Shoulder Test (SST), and visual analog scale (VAS) at 2 years following shoulder arthroplasty correlates with overall patient satisfaction.

Methods

This was a single-institution, retrospective, cohort study of all patients who underwent shoulder replacement from 2015 to 2019. Preoperative and 2-year postoperative ASES, SANE, SST, and VAS scores were recorded. Previously established MCID, SCB, and PASS values were used. Patients were contacted and underwent a survey to assess: (1) on a scale of 1 to 10, what is your overall satisfaction with your surgical outcome? (2) if you could go back in time, would you undergo this operation again? (yes/no); and (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess the relationship between reaching MCID, SCB, or PASS and the 3 outcome metrics above.

Results

Three hundred fifty two patients were included. Mean preoperative ASES was 42.2 ± 16.4, SANE was 35.5 ± 18.9, SST was 4.5 ± 2.6, and VAS was 5.3 ± 2.4. Mean 2-year ASES was 87.8 ± 16.0, SANE was 87.1 ± 15.7, SST was 9.8 ± 2.4, and VAS was 0.9 ± 1.8. Mean patient satisfaction was 9.0 ± 2.0, 331 (94.0%) patients would undergo surgery again, and 330 (93.8%) patients would recommend surgery. Spearman correlation coefficients were weak or very weak for reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS and all 3 study outcome metrics.

Discussion

Patient overall satisfaction is one of many considerations when indicating a patient for shoulder replacement and evaluating their ultimate long-term outcome. Reaching MCID, SCB, and PASS in ASES, SANE, SST, and VAS following shoulder arthroplasty did not correlate with a patient’s overall satisfaction, willingness to undergo surgery again, or willingness to recommend surgery to a friend or family member. Further investigation into the reliability and clinical value of currently defined MCID, SCB, and PASS metrics is needed.