Safe and effective is not always acceptable: The case for PASS scores in foot and ankle orthopedic surgery

Objective: To determine whether additional perspectives would be added to surgical reports in the foot and ankle literature by including outcomes for patient acceptable symptomatic state (PASS) (value beyond which the residual symptoms are felt to be acceptable) to minimum clinically important difference (MCID) outcomes (minimal amount of change that is felt to be clinically significant). Methods: Visual analog scale (VAS) pain was chosen as a common, intuitively understandable patient-reported outcome for which PASS thresholds have been established in a variety of orthopedic conditions. A total of 21 consecutive studies in Foot and Ankle International from December 2020 to August 2022 that reported VAS scores before and after an intervention were included. Improvement beyond an MCID of 2/10 VAS pain was noted, and a 2/10 VAS PASS threshold was used. Subjective ratings of success were also extracted. Results: All 21 studies reported improvement in VAS pain beyond the MCID, and 15 (71%) reported subjectively successful results. Based on a VAS PASS threshold of 2/10, successful results were observed in only 13 studies (62%). Conclusion: Residual pain above the threshold that is acceptable to patients is frequently present in foot and ankle surgery, despite the common reporting of subjectively positive results. This demonstration illustrates that using PASS thresholds, in addition to improvement beyond an MCID, provides further context for determining successful surgical outcomes. Level of evidence III; Retrospective Comparative Study.