Levin Jay M, Boyle Spencer, Winkelman Robert D, Tanenbaum Joseph E, Abdullah Kalil G, Steinmetz Michael P, Mroz Thomas E
Center for Spine Health, Cleveland Clinic.
Case Western Reserve University School of Medicine.
Clin Spine Surg. 2018 Aug;31(7):E368-E374. doi: 10.1097/BSD.0000000000000665.
This was a retrospective cohort study.
The main objectives of this study were: (1) to determine whether patient-reported allergies (PRAs) are associated with patient satisfaction scores, and (2) to clarify the association between PRAs and preoperative anxiety and depression in a lumbar spine surgery population.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to measure the patient experience and there is concern that psychosocial factors are unaccounted for. Interestingly, PRAs have been linked to concurrent mood and other psychiatric disorders, as well as poor clinical outcomes in the orthopedic surgery setting.
HCAHPS survey data, patient demographics, surgical characteristics, and preoperative health status were obtained for each patient. Allergies were categorized as medical (ie, medications) and environmental (ie, food, animals). Univariable and multivariable logistic regression models were used to determine whether the number of medical and environmental PRAs are associated with HCAHPS scores. In addition, multivariable logistic regression was used to analyze the association between PRAs and psychological distress.
In 421 patients included, PRAs were associated with lower HCAHPS scores under several dimensions of the patient experience of care, including: nursing communication, pain management, communication about medicines, and transition of care. Medical PRAs was an independent predictor of low satisfaction with communication about a medication's side effects [odds ratio (OR), 0.88; P=0.03] and understanding the purpose for new medications (OR, 0.90; P=0.03). Environmental PRAs was an independent predictor of low satisfaction with both communication about a medication's side effects (OR, 0.68; P=0.03), and pain control (OR, 0.67; P=0.01). Moreover, having a PRA (OR, 1.64; P=0.04) was associated with EuroQol-5 Dimensions anxiety/depression and having an environmental PRA (OR, 2.13; P=0.03) was associated with depression.
These findings highlight the potential utility of PRAs to help identify patients with psychological distress who are at risk for a poor experience of lumbar spine surgery.
这是一项回顾性队列研究。
本研究的主要目的是：（1）确定患者报告的过敏情况（PRA）是否与患者满意度评分相关，以及（2）阐明腰椎手术人群中PRA与术前焦虑和抑郁之间的关联。
目前使用医院医疗服务提供者和系统消费者评估（HCAHPS）调查来衡量患者体验，人们担心心理社会因素未被考虑在内。有趣的是，PRA与并发的情绪和其他精神障碍以及骨科手术环境中的不良临床结果有关。
获取每位患者的HCAHPS调查数据、患者人口统计学信息、手术特征和术前健康状况。过敏被分为医疗类（即药物）和环境类（即食物、动物）。使用单变量和多变量逻辑回归模型来确定医疗和环境类PRA的数量是否与HCAHPS评分相关。此外，使用多变量逻辑回归分析PRA与心理困扰之间的关联。
在纳入的421例患者中，PRA在护理体验的几个维度下与较低的HCAHPS评分相关，包括：护理沟通、疼痛管理、药物沟通以及护理过渡。医疗类PRA是对药物副作用沟通满意度低的独立预测因素[比值比（OR），0.88；P = 0.03]以及对新药用途理解满意度低的独立预测因素（OR，0.90；P = 0.03）。环境类PRA是对药物副作用沟通满意度低（OR，0.68；P = 0.03）以及疼痛控制满意度低（OR，0.67；P = 0.01）的独立预测因素。此外，有PRA（OR，1.64；P = 0.04）与欧洲五维健康量表焦虑/抑郁相关，有环境类PRA（OR，2.13；P = 0.03）与抑郁相关。
这些发现突出了PRA在帮助识别有心理困扰风险且腰椎手术体验不佳的患者方面的潜在效用。
