1 Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA.
Foot Ankle Int. 2018 Aug;39(8):949-953. doi: 10.1177/1071100718769667. Epub 2018 Apr 12.
Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery.
To determine if PRAs are linked to poorer operative outcomes, we retrospectively identified 159 patients who underwent elective foot and ankle surgery. PRA data were obtained via chart review, and patient-reported outcomes were assessed preoperatively and postoperatively via multiple domains, including Patient Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, and depression measures. Consistent with prior methodology, we compared outcome measures (preoperative, postoperative, and the change in outcome scores) between patients without self-reported allergies to patients with at least 1 PRA.
There were 159 patients studied; 79 patients had no allergies listed, and 80 patients had at least 1 PRA. Of the 80 patients with at least 1 PRA, there were a total of 170 possible allergies. There were no differences in preoperative, postoperative, or the change in outcome scores for all PROMIS measures (physical function, pain interference, and depression; P > .05) between patients with at least 1 PRA and those patients without any listed PRAs.
We were unable to prove our hypothesis that PRAs were linked to poorer patient-reported outcomes following foot and ankle surgery. Closer review of the published reports linking PRAs to worse total joint arthroplasty outcomes revealed data that, while statistically significant, are likely not clinically relevant. Our negative findings, then, may in fact parallel prior studies on hip, knee, and shoulder arthroplasty patients. The presence of PRAs does not appear to be a risk factor for suboptimal outcomes in foot and ankle surgery.
Level III, comparative series.
识别可能预示手术结果较差的术前风险因素仍然是当前关注的话题。在髋关节和膝关节置换患者中，患者报告的过敏症 (PRA) 的存在与关节置换后更严重的疼痛和功能有关。然而，这些结果并未在所有研究中得到复制，包括在肩关节置换病例中。PRA 对足部和踝关节结果的影响尚未得到研究。我们研究的目的是评估 PRA 是否会影响足部和踝关节手术的患者报告结果。
为了确定 PRA 是否与较差的手术结果相关，我们回顾性地确定了 159 名接受择期足部和踝关节手术的患者。通过病历回顾获取 PRA 数据，通过多个领域（包括患者报告的结果测量信息系统（PROMIS）身体功能、疼痛干扰和抑郁测量）在术前和术后评估患者报告的结果。与先前的方法一致，我们将没有自我报告过敏症的患者与至少有 1 种 PRA 的患者的结果测量值（术前、术后和结果评分的变化）进行了比较。
共研究了 159 名患者；79 名患者没有列出过敏症，80 名患者至少有 1 种 PRA。在至少有 1 种 PRA 的 80 名患者中，共有 170 种可能的过敏症。在所有 PROMIS 测量（身体功能、疼痛干扰和抑郁）的术前、术后或结果评分变化方面，至少有 1 种 PRA 的患者与没有任何列出的 PRA 的患者之间没有差异（P >.05）。
我们无法证明我们的假设，即 PRA 与足部和踝关节手术后患者报告的结果较差有关。更仔细地审查将 PRA 与更差的全关节置换结果联系起来的已发表报告显示，虽然数据具有统计学意义，但可能没有临床意义。然后，我们的阴性发现实际上可能与先前关于髋关节、膝关节和肩关节置换患者的研究相似。PRA 的存在似乎不是足部和踝关节手术结果不理想的危险因素。
III 级，比较系列。
