School of Rehabilitation Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Int Orthop. 2018 Oct;42(10):2295-2300. doi: 10.1007/s00264-018-3833-y. Epub 2018 Feb 17.
Variations in hospital length of stay (LOS) and function are present after hip or knee arthroplasty. Comorbidity and performance measures have been associated with post-operative outcomes. It is however not known if both independently contribute to outcome prediction. The objective of this study was to evaluate the combined predictive ability of comorbidity scores (American Society of Anesthesiologists classification system (ASA), Charlson comorbidity index (CCI), 2008 version of the CCI (CCI08)) and a performance measure (Timed-Up-and-Go (TUG)) on LOS and short-term function in patients undergoing knee or hip arthroplasty.
One hundred eight patients undergoing hip or knee arthroplasty were assessed preoperatively with the ASA, CCI, CCI08, and TUG. LOS was determined through administrative data. The Older Americans Resources and Services ADL questionnaire (OARS) was used to assess function two and six weeks after surgery. Logistic regression was used to assess the relationship between pre-operative assessments and LOS and OARS scores.
Both the ASA and TUG significantly contributed to LOS prediction. Odds ratio (OR) was 3.57 (95% confidence interval (CI) 1.26-10.07) for the ASA, and 2.18 (95% CI 1.67-4.15) for a one-standard deviation (SD) increase of 4.45 s of the TUG. Only the TUG was predictive of two weeks function and trending towards significance for six weeks function. One SD TUG increase yielded an OR of 2.14 (95% CI 1.53-3.79) for two week function.
The TUG and ASA can be used pre-operatively in combination to predict LOS, and TUG can also be used to predict short-term post-operative function.
髋关节或膝关节置换术后，患者的住院时间（LOS）和功能存在差异。合并症和绩效指标与术后结果相关。然而，尚不清楚两者是否独立有助于预测结果。本研究的目的是评估合并症评分（美国麻醉医师协会分类系统（ASA）、Charlson 合并症指数（CCI）、CCI08 版本）和一项绩效指标（计时起立行走测试（TUG））对 LOS 和膝关节或髋关节置换术后短期功能的综合预测能力。
108 例接受髋关节或膝关节置换术的患者术前接受 ASA、CCI、CCI08 和 TUG 评估。通过行政数据确定 LOS。术后 2 周和 6 周使用老年人资源和服务活动能力问卷（OARS）评估功能。使用逻辑回归评估术前评估与 LOS 和 OARS 评分之间的关系。
ASA 和 TUG 均显著有助于 LOS 预测。ASA 的优势比（OR）为 3.57（95%置信区间（CI）1.26-10.07），TUG 增加一个标准差（SD）4.45 秒的 OR 为 2.18（95% CI 1.67-4.15）。只有 TUG 能预测 2 周功能，且对 6 周功能有显著趋势。TUG 增加一个 SD 的 OR 为 2.14（95% CI 1.53-3.79），用于预测 2 周功能。
TUG 和 ASA 可在术前结合使用预测 LOS，TUG 也可用于预测术后短期功能。
