Gandhi Rajiv, Davey J Roderick, Mahomed Nizar N
Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada.
J Rheumatol. 2008 Dec;35(12):2415-8. doi: 10.3899/jrheum.080295. Epub 2008 Nov 1.
The incidence of patient-reported dissatisfaction following total joint arthroplasty can be up to 30%. Our aim was to identify the preoperative patient-level predictors of patient dissatisfaction 1 year after surgery.
We surveyed 1720 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, comorbidities, and education were recorded. Joint functional status and patient quality of life were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Study Short Form-36 (SF-36) scales, respectively. Patient satisfaction with surgery was determined with 4 survey questions at 1-year followup.
There were no significant differences in demographic data between satisfied (n = 1290) and dissatisfied patients (n = 430). Logistic regression modeling showed that a lower preoperative SF-36 Mental Health score independently predicted patient dissatisfaction with surgery, adjusted for all relevant covariates (p < 0.05). We found no correlation between patient satisfaction and WOMAC change scores at 1-year followup (p = 0.31).
Preoperative mental health is an important factor to consider when understanding patient satisfaction with surgery. Interventions to reduce psychological distress prior to surgery should be studied to determine if they may improve subjective outcomes of patients undergoing joint replacement surgery.
患者报告的全关节置换术后不满意发生率可达30%。我们的目的是确定术后1年患者不满意的术前患者层面预测因素。
我们对1720例行初次髋关节或膝关节置换手术的患者进行了调查。记录了包括人口统计学数据、体重指数、性别、合并症和教育程度等相关协变量。分别使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和医学结局研究简表36（SF-36）量表在基线和1年随访时评估关节功能状态和患者生活质量。在1年随访时通过4个调查问题确定患者对手术的满意度。
满意患者（n = 1290）和不满意患者（n = 430）之间的人口统计学数据无显著差异。逻辑回归模型显示术前SF-36心理健康评分较低独立预测患者对手术不满意，对所有相关协变量进行校正后（p < 0.05）。我们发现1年随访时患者满意度与WOMAC变化评分之间无相关性（p = 0.31）。
术前心理健康是理解患者对手术满意度时需要考虑的重要因素。应研究术前减轻心理困扰的干预措施，以确定它们是否可能改善关节置换手术患者的主观结局。
