Herickhoff Paul K, Callaghan John J, Johnston Richard, Marsh J Lawrence, Clark Charles R, Noiseux Nicolas
University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, John Pappajohn Pavilion, Lower Level, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Iowa Orthop J. 2010;30:109-14.
Survey studies have concluded that a lack of consensus exists between orthopaedic surgeons on indications for total hip and knee arthroplasty. Geographic variation in the rates of these operations has raised concerns that some surgeons inappropriately indicate healthier patients for surgery than others. The objective of this study was to compare primary hip and knee arthroplasty patients'pre-operative validated outcome scores between four orthopaedic surgeons operating at a single academic institution from 2003 to 2007.
A retrospective chart review was performed using CPT-4 codes to identify patients who underwent primary total hip or knee arthroplasty at our institution between June 2003 and June 2007. Pre-operative SF-36 and WOMAC scores were recorded for each patient Patient demographics including age, gender, body mass index (BMI), number of co-morbidities, life orientation score (a measure of patient optimism), smoking and alcohol use, education level, and occupation were also recorded. Statistical analysis using unbalanced analysis of variance (ANOVA) and Chi-Square test were used to compare data between the surgeons, with statistical significance set at P < 0.05.
There was no statistically significant difference in SF-36 or WOMAC stiffness and function scores between the surgeons. There was a small difference in WOMAC pain scores between the surgeons'total knee patients, but not total hip patients. The number of primary hip and total knee replacements performed by each surgeon ranged from 151 to 955, with a total of 1896 primary joint replacements by the four surgeons during the study period.
Patients undergoing primary total joint arthroplasty at our institution were equally disabled between four surgeons, despite the surgeons performing variable numbers of the procedures. Further comparative effectiveness research using validated outcome measures is warranted.
调查研究得出结论，骨科医生在全髋关节和膝关节置换术的适应症方面缺乏共识。这些手术发生率的地域差异引发了人们的担忧，即一些外科医生比其他医生更不适当地为健康状况较好的患者安排手术。本研究的目的是比较2003年至2007年在同一学术机构执业的四位骨科医生的初次髋关节和膝关节置换术患者术前经过验证的结局评分。
采用CPT - 4编码进行回顾性病历审查，以确定2003年6月至2007年6月期间在我们机构接受初次全髋关节或膝关节置换术的患者。记录每位患者的术前SF - 36和WOMAC评分。还记录了患者的人口统计学特征，包括年龄、性别、体重指数（BMI）、合并症数量、生活取向评分（患者乐观程度的一种衡量指标）、吸烟和饮酒情况、教育水平以及职业。使用不平衡方差分析（ANOVA）和卡方检验进行统计分析，以比较外科医生之间的数据，设定统计学显著性为P < 0.05。
外科医生之间的SF - 36或WOMAC僵硬和功能评分没有统计学显著差异。外科医生的全膝关节置换患者的WOMAC疼痛评分存在微小差异，但全髋关节置换患者不存在。每位外科医生进行的初次髋关节置换和全膝关节置换数量从151例到955例不等，在研究期间，四位外科医生共进行了1896例初次关节置换。
在我们机构接受初次全关节置换术的患者，尽管四位外科医生进行的手术数量不同，但他们的残疾程度相当。有必要使用经过验证的结局指标进行进一步的比较有效性研究。
