骨科医生在膝关节置换手术前如何告知患者？一项横断面研究。
How do orthopaedic surgeons inform their patients before knee arthroplasty surgery? A cross-sectional study.
作者信息
Mahdi Aamir, Nyman Maria Hälleberg, Wretenberg Per
机构信息
Department of Orthopaedics, Örebro County, Sweden.
Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
出版信息
BMC Musculoskelet Disord. 2018 Nov 24;19(1):414. doi: 10.1186/s12891-018-2345-7.
BACKGROUND
Total knee arthroplasty (TKA) is a successful and common procedure. However, 6-28% of patients are dissatisfied postoperatively. The provision of preoperative patient information, inquiring about patients' expectations, and taking a psychiatric history are essential parts of both preoperative evaluation and postoperative outcome. The aim of this study was to investigate how orthopaedic knee surgeons in Sweden inform their patients before surgery.
METHODS
A questionnaire was distributed to all knee surgeons performing TKA in Sweden. Responses were received from 60 of the 65 orthopaedic departments performing TKA in Sweden (92%), covering 219 of the approximately 311 knee surgeons at the 65 departments (70%). The answers were analysed with descriptive statistics. A content analysis of the surgeons' opinions was also performed using a thematic method.
RESULTS
In terms of information provision, 58% of the surgeons always gave written information while 92% informed orally. Only 44% always asked about the patient's expectations, and only 42% always informed patients about the 20% dissatisfaction rate after TKA. Additionally, 24% never operated on mild indication of arthrosis, 20% always took a psychiatric history, and half never or seldom consulted a psychiatrist. However, all the knee surgeons believed in a psychiatric impact on TKA outcome. Qualitative analysis revealed five common causes of patient dissatisfaction, which in descending frequency were: patients' expectations, choice of patients to operate on, surgical factors, combinations of factors, and insufficient information provision to patients.
CONCLUSIONS
Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient's expectations, and psychiatric assessment.
背景
全膝关节置换术（TKA）是一种成功且常见的手术。然而，6%至28%的患者术后不满意。提供术前患者信息、询问患者期望以及了解精神病史是术前评估和术后结果的重要组成部分。本研究的目的是调查瑞典的骨科膝关节外科医生在手术前如何向患者提供信息。
方法
向瑞典所有进行TKA的膝关节外科医生发放了一份问卷。瑞典65个进行TKA的骨科科室中有60个回复了问卷（92%），涵盖了这65个科室约311名膝关节外科医生中的219名（70%）。对答案进行了描述性统计分析。还采用主题方法对外科医生的意见进行了内容分析。
结果
在信息提供方面，58%的外科医生总是提供书面信息，92%进行口头告知。只有44%的医生总是询问患者的期望，只有42%的医生总是告知患者TKA术后有20%的不满意率。此外，24%的医生从不为轻度关节病指征进行手术，20%的医生总是了解精神病史，一半的医生从不或很少咨询精神科医生。然而，所有膝关节外科医生都认为精神因素会影响TKA的结果。定性分析揭示了患者不满意的五个常见原因，按出现频率从高到低依次为：患者期望、手术患者的选择、手术因素、多种因素组合以及向患者提供的信息不足。
结论
瑞典的膝关节外科医生对术前患者信息的重要性、患者期望的影响以及精神疾病有相当的认识。然而，在提供书面信息、询问患者期望和进行精神评估方面，他们需要改进术前流程。
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