How Patient Decision-Making Characteristics Affect Satisfaction in Facial Plastic Surgery

A Prospective Pilot Study

Jeremie D. Oliver, B.S., B.A.; Deanna C. Menapace, M.D.; Jeffrey P. Staab, M.D., M.S.; Oren Friedman, M.D.; Chelsey Recker, P.A.-C.; Grant S. Hamilton, M.D.

Disclosures

Plast Reconstr Surg. 2019;144(6):1487-1497.

Conclusions

Patients who were less than extremely satisfied were more likely to exhibit, with statistical significance, maximizer-type decision making styles at the 6-month postoperative visit. This remained a strong trend at 12 months. In this pilot study, no other psychometric variables were associated with satisfaction. The maximizer/satisficer survey captures an aspect of patient care not traditionally measured by standard clinical psychometric screening tools, and it can be used in patients undergoing aesthetic, functional, or reconstructive procedures.

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Acknowledgment
Funding was provided internally by the Mayo Clinic Department of Otorhinolaryngology.

Table 1. Demographics and Clinical Characteristics of Study Participants*
Demographics	Aesthetic	Functional	Reconstructive	p
Surgical indication
Age, yr				—
Mean	43.5	38.4	50.6
Range	19–67	18–70	18–73
Sex				0.59
Female	15	13	12
Male†	5	7	8
Psychiatric symptoms
Depression: PHQ-9				0.84
Mean ± SD	3.1 ± 4.6	3.0 ± 4.9	2.2 ± 3.2
No. positive‡	1	2	1
State anxiety: GAD-7				0.72
Mean ± SD	2.6 ± 3.2	2.0 ± 4.1	2.6 ± 3.3
No. positive‡	1	1	1
Illness anxiety: SHAI				0.51
Mean ± SD	8.2 ± 4.8	7.0 ± 4.7	7.6 ± 4.5
Personality traits
NEO-PI standardized scores (mean ± SD)§
Neuroticism	49.8 ± 10.2	42.3 ± 7.8\|\|	49.2 ± 7.1	0.03¶
Extraversion	50.8 ± 11.4	51.7 ± 10.0	55.7 ± 9.8	0.49
Openness	51.6 ± 11.2	51.8 ± 11.6	45.1 ± 10.0	0.26
Agreeableness	48.8 ± 11.7	49.5 ± 12.7	37.1 ± 16.8\|\|	0.05¶
Conscientiousness	50.2 ± 10.2	55.3 ± 10.8	57.1 ± 8.0	0.18
Decision-making style
Mean maximzer/satisficer score ± SD§	42.1 ± 10.0	41.2 ± 8.1	41.0 ± 10.8	0.94

PHQ-9, Patient Health Questionnaire; GAD-7 Generalized Anxiety Disorder Scale; SHAI, Short Health Anxiety Inventory; NEO-PI, NEO Personality Inventory.
*Mean neuroticism score for the functional group was significantly lower than the population norm (<45) and lower than both of the other groups. The mean agreeableness score in the reconstructive group was lower than the population norm (<45) and trended lower than the other two groups; p = no statistically significant difference between groups.
†χ² test.
‡Kruskal-Wallis test.
§One-way analysis of variance.
||Significant in pairwise t tests.
¶Statistically significant.

Table 2. Maximizer/Satisficer Survey Scores versus Satisfaction*
Patient Satisfaction	Maximizer/Satisficer Scores (Mean ± SD)
Patient Satisfaction	3 Mo Postoperatively	6 Mo Postoperatively	12 Mo Postoperatively
Extremely satisfied	38.3 ± 10.9	35.0 ± 9.7	36.5 ± 11.4
Less than extremely satisfied	42.5 ± 10.4	43.7 ± 9.1†	43.0 ± 9.3‡

*Patients exhibiting predominately maximizer characteristics categorized their satisfaction as less than extremely satisfied more often than the patients with more satisficer decision-making tendencies at the 6-mo postoperative interval, which maintained a trend at the 1-yr postoperative interval.
†p < 0.04 (t test).
‡p < 0.057 (t test).

Table 3. Retrospective Review of Patients' Records for Any Critical Comments Made about Their Surgical Outcomes*
Patient	MaxSat Preoperative Total	POSQ Total			Complications	Complaints	Surgeon Evaluation
Patient	MaxSat Preoperative Total	3 Mo	6 Mo	12 Mo	Complications	Complaints	Surgeon Evaluation
1	61	38	24	29	Small pneumothorax	None	WNL
2	59	40		40	None	None	WNL
3	57	—	39	33	None	None	WNL
4	55	2	0	0	None	"Bump on side of nose"	No deformity
5	54	38	38	37	None	None	WNL
6	54	35	29	38	None	None	WNL
7	54	35	35	32	None	Right nostril smaller than left	Agree, offered composite graft; declined
8	53	38	26		None	None	WNL
9	52	37	38	37	None	None	WNL
10	52	30	40	—	None	None	WNL
11	52	34	38	—	None	None	WNL
12	52	—	37	38	None	Concern with a small bump that she can palpate and see	Small bony protuberance on the left side where the osteotomy was; hyper-pigmentation
13	51	35	—	—	None	Scarring	Prominent mid-forehead scars
14	51	40	27	36	None	Worsened nasal obstruction	Inferior turbinate hypertrophy
15	50		34	30	None	None	WNL
16	49	40	40	40	None	None	WNL
17	47	32	27	28	None	None	WNL
18	47	—	37	—	None	None	WNL
19	45	37	31	28	None	None	WNL
20	45	37	35	37	None	None	WNL
21	44	37	35	32	None	None	Small hypertrophic scar
22	44	32	26	32	None	None	Redundant tissue near the repair site
23	44	25	28	24	None	None	None
24	44	—	—	—	None	None	WNL
25	43	31	31	33	Small hematoma	None	WNL
26	43	33	—	—	None	Allergies	Edematous mucosa
27	43	—	—	—	None	None	WNL
28	42	39			None	Crusting	Significant crusting
29	42	40	—	40	None	Headache	Consulted headache clinic and improved
30	41	—	37	35	None	None	WNL
31	41		34		None	None	WNL
32	41	40		38	None	Swelling	Swelling in the area of the anterior septal angle has resolved
33	41		32	37	None	Persistent callous	Persistent callous
34	40	33	27	24	None	None	WNL
35	40		40	39	None	Painful sores	ucosa is pink and appears healthy
36	40	—	—	—	None	None	WNL
37	40	—	—	—	None	None	WNL
38	39	39	38	36	None	None	WNL
39	39	40	36	40	None	None	WNL
40	39	—	—	—	None	None	WNL
41	37		36		None	Sinusitis	WNL
42	37	39	38	37	None	Peeling skin	Small telangiectasias
43	36	36	35	33	None	None	WNL
44	36	40	40	40	None	Intermittent rhinorrhea and otalgia	External auditory canals were much less inflamed than at her previous visit
45	36				None	None	None
46	35	40	40	40	None	None	WNL
47	35	37			None	Bothered by alar retraction	I think that her alar margins have moved up a bit
48	34				None	Right nostril a little bit smaller on inside.	Some asymmetry of her nostrils with the left nostril being smaller than the right
49	34	29	36	9	None	Callus on the ascending process of the maxilla	Callus on the ascending process of the maxilla, offered treatment
50	32	22	3	5	None	"Residual callous"	Offered rhino burr, never returned
51	31	40	40	40	None	None	WNL
52	30	39	40	38	None	Persistent numbness over the tip of her nose	WNL
53	30	40	40	37	None	Small dot on her chin incision	Tiny white bump at the medial aspect of her chin incision
54	30		39	37	None	Right ear is more prominent than the left	Right ear is more prominent than the left
55	28	38	36	37	None	None	WNL
56	27	39	36	40	None	None	WNL
57	26	20	24	33	None	None	Noticeable scar in the left forehead
58	24	40	40	40	None	None	WNL
59	23	40	40	40	None	Persistent crusting	A slight height mismatch at the perimeter of the graft; there is a small amount of crusting on the inferior aspect of the graft
60	17	30			None	Could feel graft	Caudal edge of the batten graft on the left is palpable but is nonobstructive

POSQ, Postoperative Satisfaction Questionnaire; MaxSat, maximizer/satisficer survey; WNL, within normal limits.
*There were no instances of serious adverse outcomes, and no statistically significant relationships between patient satisfaction scores at 3, 6, or 12 months and their reported objective outcomes.