Patients' Expectations Predict Surgery Outcomes: A Meta-Analysis

Several studies indicate that patients' presurgical expectations can influence postsurgical health outcome. To estimate the potential for clinical exploitation of this association, a meta-analysis of prospective studies which assess the association between patients' presurgical expectations and postsurgical quality of life is applied to accumulate the overall effect. We searched the databases MEDLINE, CENTRAL, and PsychINFO for English- and German-language articles published from 1980 until December 2013. Additionally, manual searches of bibliographies of retrieved articles and relevant reviews were conducted. Prospective studies measuring presurgical expectations and postsurgical quality of life in patients aging 18-65 were selected. Correlations between presurgical expectations and postsurgical quality of life were extracted or provided by the authors. The search yielded 21 prospective studies (including 2611 patients undergoing surgery) with a follow-up period ranging from 1 week to 13 years. The pooled correlations were 0.369 (95 % confidence interval (CI), 0.264 to 0.466; P for heterogeneity < 0.001; random-effects model) for overall quality of life (11 studies), 0.126 (95 % CI, 0.079 to 0.172; P for heterogeneity = 0.63; random-effects model) for physical quality of life (12 studies), and 0.208 (95 % CI, 0.113 to 0.299; P for heterogeneity < 0.001; random-effects model) for mental quality of life (12 studies), indicating low to moderate associations between presurgery patients' expectations and postsurgery quality of life. These results confirm the importance of patients' expectations in the prediction of postsurgical outcomes and underline the necessity to optimize these expectations in order to improve postoperative quality of life.