EP8.23 Reporting Patient Satisfaction with the Outcome of Orthopedic Surgery: Threshold-Based Definitions May be an Unreliable Estimate of Patient Opinion

Abstract Introduction The Patient Acceptable Symptom State (PASS) is a widely used clinically relevant threshold for relating patient satisfaction to patient-reported outcomes (PROs). The purpose of this study is to assess the accuracy of PASS thresholds relative to patient satisfaction in patients undergoing hip arthroscopy and to identify risk factors for PASS achievement misalignment when compared to a patient’s actual satisfaction with surgery. Methods Patients were included within the study if they had preoperative and minimum 2-year follow-up with completed PROs following primary hip arthroscopy. Receiver Operating Characteristic curves were utilized to establish PASS thresholds for each PRO. Model integrity was evaluated through the Area Under the Curve (AUC). A false-negative PASS was defined as failing the PASS threshold despite reporting satisfaction with surgery, whereas false positive PASS was defined as meeting the PASS threshold despite not being satisfied with surgery. Multivariate regression was performed to identify risk factors associated with inaccurate PASS determination. Results 497 patients were included in the study. PASS threshold AUC ranged from 0.85 to 0.89, with accuracy ranging from . The positive predictive value for PASS achievement ranged from 0.94 to 0.96 while the negative predictive value ranged from 0.46 to 0.59 for each PRO. 31.8% of patients were found to have PASS misalignment for at least one PRO, with 26.0% exhibiting false-negative PASS and 5.8% exhibiting false-positive PASS. Lower preoperative activity level was among the strongest predictors for a false-negative PASS (p<0.01 for all PROs on multivariate analysis). Conclusion This study demonstrates that PASS thresholds, while accurately predicting satisfied patients, were less reliable at predicting unsatisfied patients, with a lower NPV and a larger number of patients that did not meet PASS who were actually satisfied with surgery. Patient satisfaction is affected by multiple factors, including patient preoperative activity level, and, when available, the practice of reporting actual patient satisfaction (positive response to the PASS question), in addition to calculated threshold achievement is recommended.