Bitzer E M, Dörning H, Schwartz F W
Institut für Sozialmedizin, Epidemiologie und Gesundheitssystemforschung (ISEG), Hannover.
Rehabilitation (Stuttg). 2001 Feb;40(1):43-9. doi: 10.1055/s-2001-12126.
The study was conducted in co-operation with a German health insurance fund (Gmünder Ersatzkasse, GEK) to identify determinants of outcomes of hip surgery from the patient's perspective.
In September 1997 all beneficiaries (age 40-75 yrs.) who had been treated in hospital for osteoarthrosis of the hip (ICD-715/820) (n = 1352) were sent a questionnaire on average 5.2 months (T1) postoperatively. The standardized questionnaire contained, among others, items about pre- and postoperative subjective assessment of disease specific symptoms (Lequesne Index), complications, comorbidity (Katz-Index), health related quality of life (SF-36) and discharge (home or for inpatient rehabilitation). The response rate at T1 was 67.8%. Patients with hip surgery (n = 390) were sent a second questionnaire 17.2 months (T2) postoperatively. After the two mailings, data from 293 patients were available for analysis. Descriptive and multivariate analyses (GSK model) were performed to reveal determinants of disease specific symptom alleviation.
Patients (57.6% male) were 61 years of age on average, and 61.2% reported no comorbidity. 88.4% had undergone total hip replacement. A third of the patients reported at least one complication. 70.6% were discharged for inpatient rehabilitation. Univariately, a substantial (and statistically highly significant) decrease was observed in the Lequesne Index over time: (recalled) preoperative: 14.2 points; postoperative T1: 5.6 pts.; postoperative T2: 4.4 pts. This result is confirmed by multivariate analyses (estimated values: pre = 13.8; T1 = 6.9; T2 = 5.7) although it is modified by an interaction effect between the variables "Lequesne Index" and "Discharge". In patients discharged home, the preoperative Lequesne Index is an estimated 13.3, at T1 = 6.9 and T2 = 6.2. The respective estimated values for patients discharged for inpatient rehabilitation are: preoperative 14.3; T1 = 6.9; T2 = 5.2.
Patients receiving inpatient rehabilitation scored higher on the Lequesne Index (higher burden of disease) before hip surgery. In the short term, their improvements are higher than those of the patient group discharged home (-7.4 pts. versus -6.4 pts.) and continue to be higher in the medium term (-9.1 pts. versus -7.1 pts.). Inpatient rehabilitation after hip surgery leads to better disease specific health outcomes than direct discharge home.
本研究与德国一家健康保险基金（京德替代保险基金，GEK）合作开展，旨在从患者角度确定髋关节手术预后的决定因素。
1997年9月，所有因髋关节骨关节炎（ICD - 715/820）在医院接受治疗的受益人（年龄40 - 75岁）（n = 1352）在术后平均5.2个月（T1）时收到一份问卷。标准化问卷除其他内容外，还包含有关疾病特定症状的术前和术后主观评估（Lequesne指数）、并发症、合并症（Katz指数）、健康相关生活质量（SF - 36）以及出院情况（回家或住院康复）的项目。T1时的回复率为67.8%。接受髋关节手术的患者（n = 390）在术后17.2个月（T2）时收到第二份问卷。经过两次邮寄后，有293名患者的数据可供分析。进行了描述性和多变量分析（GSK模型）以揭示疾病特定症状缓解的决定因素。
患者平均年龄61岁（男性占57.6%），61.2%报告无合并症。88.4%接受了全髋关节置换术。三分之一的患者报告至少有一项并发症。70.6%出院后接受住院康复治疗。单因素分析显示，随着时间推移，Lequesne指数有显著（且在统计学上高度显著）下降：（回忆的）术前：14.2分；术后T1：5.6分；术后T2：4.4分。多变量分析证实了这一结果（估计值：术前 = 13.8；T1 = 6.9；T2 = 5.7），尽管它受到变量“Lequesne指数”和“出院”之间的交互作用影响。对于出院回家的患者，术前Lequesne指数估计为13.3，T1时为6.9，T2时为6.2。对于出院后接受住院康复治疗的患者，相应的估计值为：术前14.3；T1 = 6.9；T2 = 5.2。
接受住院康复治疗的患者在髋关节手术前Lequesne指数得分较高（疾病负担较重）。短期内，他们的改善程度高于出院回家的患者组（-7.4分对 -6.4分），并且在中期继续保持较高水平（-9.1分对 -7.1分）。髋关节手术后进行住院康复治疗比直接出院回家能带来更好的疾病特定健康预后。
