Should patients be optimistic about surgery? Resolving a conflicted literature

ABSTRACT

Following surgery, some patients suffer distress, disappointment, regret, poor adjustment, and poor quality-of-life. Surgeons may define ‘success’ based on objective clinical outcomes, but patients’ perceptions of surgical success rely primarily on a comparison to their initial expectations. We review the literature on the relationship between patients’ surgical expectations and psychosocial outcomes and attempt to resolve a conflict in the literature. Specifically, we propose that conflicting conclusions regarding the merits of optimism primarily stem from differing methodological approaches by researchers in the field. Studies that examine preoperative expectations in isolation typically conclude that optimism is positively associated with beneficial psychosocial outcomes. Studies that compare preoperative expectations to objective surgical outcomes typically conclude that optimism, particularly unrealistic optimism, is associated with detrimental psychosocial outcomes. As a whole, the evidence strongly supports an association between optimistic expectations and positive psychosocial outcomes following surgery if those expectations are based in reality. If preoperative optimism ultimately turns out to be unrealistic, however, it is likely to be a postoperative liability.

KEYWORDS:

• Expectations
• optimism
• quality-of-life
• distress
• adjustment
• surgery

Acknowledgements

We thank Dr Arnold Tabuenca for his insightful feedback on this manuscript and Michael D. Dooley, M.A., Angelica Falkenstein, M.A., Desiree Lopez, Monica Salazar, Rami Khoury, and Madison Shasteen for their help collecting relevant research papers. The authors collectively conceived, researched, and wrote this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. In expectation-only studies, 32% of analyses examined expectations for recovery, 29% general surgical outcomes, 14% pain, 14% functioning, 7% return-to-work, 4% other; in expectation-comparison studies, 6% examined expectations for recovery, 41% general surgical outcomes, 24% pain, 18% functioning, 12% other.

2. In expectation-only studies, 28% of analyses examined satisfaction, 28% emotional state, 16% quality-of-life, 16% mental health, 12% other; in expectation-comparison studies, 47% examined satisfaction, 20% emotional state, 20% adjustment, 13% other.