Bryan Stirling, Goldsmith Laurie J, Davis Jennifer C, Hejazi Samar, MacDonald Valerie, McAllister Patrick, Randall Ellen, Suryaprakash Nitya, Wu Amery D, Sawatzky Richard
Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
School of Population & Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
BMC Musculoskelet Disord. 2018 Nov 30;19(1):423. doi: 10.1186/s12891-018-2340-z.
Total knee arthroplasty (TKA) is the most common joint replacement surgery in Canada. Earlier Canadian work reported 1 in 5 TKA patients expressing dissatisfaction following surgery. A better understanding of satisfaction could guide program improvement. We investigated patient satisfaction post-TKA in British Columbia (BC).
A cohort of 515 adult TKA patients was recruited from across BC. Survey data were collected preoperatively and at 6 and 12 months, supplemented by administrative health data. The primary outcome measure was patient satisfaction with outcomes. Potential satisfaction drivers included demographics, patient-reported health, quality of life, social support, comorbidities, and insurance status. Multivariable growth modeling was used to predict satisfaction at 6 months and change in satisfaction (6 to 12 months).
We found dissatisfaction rates ("very dissatisfied", "dissatisfied" or "neutral") of 15% (6 months) and 16% (12 months). Across all health measures, improvements were seen post-surgery. The multivariable model suggests satisfaction at 6 months is predicted by: pre-operative pain, mental health and physical health (odds ratios (ORs) 2.65, 3.25 and 3.16), and change in pain level, baseline to 6 months (OR 2.31). Also, improvements in pain, mental health and physical health from 6 to 12 months predicted improvements in satisfaction (ORs 1.24, 1.30 and 1.55).
TKA is an effective intervention for many patients and most report high levels of satisfaction. However, if the TKA does not deliver improvements in pain and physical health, we see a less satisfied patient. In addition, dissatisfied TKA patients typically see limited improvements in mental health.
全膝关节置换术（TKA）是加拿大最常见的关节置换手术。加拿大早期的研究报告称，五分之一的TKA患者术后表示不满意。更好地了解患者满意度可为项目改进提供指导。我们调查了不列颠哥伦比亚省（BC）TKA术后患者的满意度。
从BC省各地招募了515名成年TKA患者。术前、术后6个月和12个月收集调查数据，并辅以行政健康数据。主要结局指标是患者对手术结果的满意度。潜在的满意度驱动因素包括人口统计学特征、患者报告的健康状况、生活质量、社会支持、合并症和保险状况。使用多变量增长模型预测6个月时的满意度以及满意度的变化（6至12个月）。
我们发现不满意率（“非常不满意”、“不满意”或“中立”）在6个月时为15%，12个月时为16%。在所有健康指标方面，术后均有改善。多变量模型表明，6个月时的满意度可由以下因素预测：术前疼痛、心理健康和身体健康（优势比（OR）分别为2.65、3.25和3.16），以及从基线到6个月时疼痛水平的变化（OR为2.31）。此外，6至12个月期间疼痛、心理健康和身体健康的改善预示着满意度的提高（OR分别为1.24、1.30和1.55）。
TKA对许多患者是一种有效的干预措施，大多数患者报告满意度较高。然而，如果TKA不能改善疼痛和身体健康状况，患者的满意度就会降低。此外，不满意的TKA患者通常心理健康改善有限。
