Hospital for Special Surgery, Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, NY, USA.
J Arthroplasty. 2012 Aug;27(7):1310-5. doi: 10.1016/j.arth.2011.10.031. Epub 2011 Dec 23.
This study evaluated concordance between self-reports and surgeon assessments of short-term complications. A total of 3976 primary total hip arthroplasty patients consented for an institutional registry (5/2007-12/2008); 3186 (80.1%) completed a 6-month survey; 137 (4.4%) reported deep venous thrombosis, pulmonary embolism, major bleeding, fracture, or dislocation. Patients reporting complications were called. Positive predictive values and 95% confidence intervals (95% CI) for patient self-report were measured, using surgeon assessment for comparison: pulmonary embolism, 88.9% (95% CI, 78.4%-99.4%); dislocation, 81.1% (95% CI, 75.9%-86.5%); fracture, 73.7% (95% CI, 63.8%-83.5%); deep venous thrombosis, 69.7% (95% CI, 61.9%-77.5%); major bleeding, 32.0% (95% CI, 19.4%-44.5%); any bleeding, 88.0% (95% CI, 75.3%-99.9%). Of 97 confirmed complications, 64.95% presented to outside institutions. Registry data on self-reported complications may overcome limitations of traditional methods, but data should be interpreted cautiously. Concordance was high for PE and dislocation but low for major bleeding.
本研究评估了患者自我报告与外科医生评估短期并发症的一致性。共有 3976 例初次全髋关节置换术患者同意参加机构注册研究（2007 年 5 月至 2008 年 12 月）；3186 例（80.1%）完成了 6 个月的调查；137 例（4.4%）报告了深静脉血栓形成、肺栓塞、大出血、骨折或脱位。报告并发症的患者被召回。使用外科医生评估进行比较，测量了患者自我报告的阳性预测值和 95%置信区间（95%CI）：肺栓塞为 88.9%（95%CI，78.4%-99.4%）；脱位为 81.1%（95%CI，75.9%-86.5%）；骨折为 73.7%（95%CI，63.8%-83.5%）；深静脉血栓形成 69.7%（95%CI，61.9%-77.5%）；大出血 32.0%（95%CI，19.4%-44.5%）；任何出血为 88.0%（95%CI，75.3%-99.9%）。在 97 例确诊并发症中，64.95%发生在外部机构。自我报告并发症的登记数据可能克服了传统方法的局限性，但应谨慎解释数据。PE 和脱位的一致性较高，但大出血的一致性较低。
