[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.

[jdmcnugent]

They certainly do track it because Medicare will not pay for a second hospital stay in many cases.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Ass...

Beware of unintended consequences though, hospitals are less inclined to permit riskier surgeries on unhealthy patients if they think the risk of readmissions is too high. Good luck getting your knee replacement if you are a 300lb diabetic smoker.

[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.

[Brakenshire]

You need devices which can objectively measure the strength of something like an ankle in multiple vectors of motion. And then algorithms which can combine the data into a meaningful index.

[chrisco255]

That doesn't sound very difficult. You could measure the angle that someone could extend before feeling pain, or ensure the ankle could apply a certain amount of pressure before the patient feels pain, etc.

[nradov]

It would be very difficult to bring that to market as an FDA certified medical device. And then repeat the process for every other joint.

[JimTheMan]

I doubt you would need to get the FDA involved at all.

There is basically no risk of harm from such a thing. If all you are doing is using it verify whether a surgery worked or not, then it's not actually a treatment is it? Surgeons make their own tools, jigs and tests all the time.

And if for some reason you had to, there are different grades of hard with a medical regulating body. For instance, it is super easy to develop medical tools. Harder again to do implants, harder again to do medicines.

So I want to reiterate. Not hard at all.

- source. Worked for a medical device company that did implants, wound care and medical tools. Surgeons would often ask for custom tooling or jigs through us that we would get made up for them.

[viraptor]

I'm not sure if that was sarcastic or not, but you mean devices like hanging scales and string, and a protractor?

[liability]

Ah, but it's a medically certified protractor! Disposable (for safety of course) and $500 a pop.

[harimau777]

It seems to me that squat, deadlift, and an agility test would probably cover that.

[gameswithgo]

well....get to work?

[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.