Surgical hexing can curse outcomes

Orthopaedic surgeons rely on high-level data, objective studies, and evidence-based medicine when diagnosing and treating patients. While essential for patient care, framing this information when outlining outcome expectations and discussing surgical preparation may have some inadvertent consequences. Using best practices, orthopaedic surgeons may be guilty of “surgical hexing” simply by telling a patient what is known about their stratified risk profile for joint replacement. Outcomes of elective surgery, like so much in medicine, rely heavily on a complex relationship between the surgeon and the patient that is founded on trust. With a patient-centered care model, the expectation should be that surgeons focus on not only the physical but also the holistic elements of the surgical process. In addition to appropriate surgical preparation, execution, and recovery, arthroplasty success has been shown to depend on the patient's state of mind. For example, risk stratification models now point to patient depression as a major factor in less positive results, and patients with somatization behaviors have more pain and poorer function