Mahon Jeffrey L, Bourne Robert B, Rorabeck Cecil H, Feeny David H, Stitt Larry, Webster-Bogaert Susan
Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON.
CMAJ. 2002 Nov 12;167(10):1115-21.
Waits for elective total hip arthroplasty for osteoarthritis are common in publicly funded health care systems, but they may lead to poorer postoperative outcomes and loss of health-related quality of life (HRQOL) through progressive pain and immobility during the wait. These issues have not been examined from the time of referral for surgery. Our primary objective was to test whether a longer wait was associated with poorer postoperative HRQOL.
Patients needing possible total hip arthroplasty for osteoarthritis were identified upon referral to a surgeon in London, Ont. Outcome measures, including the Western Ontario McMaster (WOMAC) Osteoarthritis Index and mobility in the 6-Minute Walk, were assessed at baseline and every 3-6 months thereafter until at least 3 months after the surgery.
Of 553 potentially eligible patients referred for surgical assessment, 123 were placed on a waiting list for total hip arthroplasty; 114 underwent the procedure, and 99 of them returned for postoperative assessment. No significant differences in HRQOL or mobility were seen postoperatively between patients with short waits and those with long waits (a priori definitions < or = 6 months and > 6 months respectively). At referral, however, patients with short waits had poorer HRQOL and were less mobile than those with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, 0.001 for pain, 0.009 for stiffness and 0.008 for function; p = 0.006 for 6-Minute Walk results). Patients with short waits experienced larger gains in these measures from the time of referral until the postoperative assessment than did patients with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, < 0.001 for pain, 0.005 for stiffness and 0.005 for function; p = 0.06 for 6-Minute Walk results). For patients with long waits, increases in the WOMAC Osteoarthritis Index total score exceeded 10% and losses in walking distance exceeded 30 m from the time of referral to surgery.
The length of wait for elective total hip arthroplasty is not associated with postoperative HRQOL and mobility. However, patients who undergo the procedure within 6 months after referral have greater disability at referral, and realize greater gains in HRQOL and mobility after surgery, than patients waiting more than 6 months. Clinically important losses in HRQOL and mobility occur in patients waiting more than 6 months.
在公共资助的医疗保健系统中，等待择期全髋关节置换术治疗骨关节炎的情况很常见，但等待期间因疼痛加剧和活动不便，可能导致术后效果较差以及健康相关生活质量（HRQOL）下降。从转诊手术之时起，这些问题就未得到研究。我们的主要目的是检验等待时间较长是否与术后较差的HRQOL相关。
在安大略省伦敦市，将转诊给外科医生的可能需要全髋关节置换术治疗骨关节炎的患者确定下来。在基线时以及此后每3至6个月评估一次结果指标，包括西安大略和麦克马斯特大学（WOMAC）骨关节炎指数以及6分钟步行试验中的活动能力，直至术后至少3个月。
在553名被转诊进行手术评估的潜在合格患者中，123名被列入全髋关节置换术等待名单；114名接受了手术，其中99名返回进行术后评估。等待时间短的患者与等待时间长的患者术后在HRQOL或活动能力方面未见显著差异（预先定义分别为等待时间≤6个月和＞6个月）。然而，在转诊时，等待时间短的患者HRQOL较差，活动能力也比等待时间长的患者弱（WOMAC骨关节炎指数总分p = 0.002，疼痛p = 0.001，僵硬p = 0.009，功能p = 0.008；6分钟步行试验结果p = 0.006）。从转诊到术后评估这段时间，等待时间短的患者在这些指标上的改善幅度比等待时间长的患者大（WOMAC骨关节炎指数总分p = 0.002，疼痛p＜0.001，僵硬p = 0.005，功能p = 0.005；6分钟步行试验结果p = 0.06）。对于等待时间长的患者，从转诊到手术，WOMAC骨关节炎指数总分增加超过10%，步行距离减少超过30米。
择期全髋关节置换术的等待时间与术后HRQOL和活动能力无关。然而，与等待超过6个月的患者相比，转诊后6个月内接受手术的患者在转诊时残疾程度更高，但术后在HRQOL和活动能力方面改善更大。等待超过6个月的患者在HRQOL和活动能力方面出现了具有临床意义的下降。
