Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopaedic Surgery, University of Illinois at Chicago Medical College, Chicago, IL.
J Arthroplasty. 2019 Apr;34(4):663-670. doi: 10.1016/j.arth.2018.12.020. Epub 2018 Dec 19.
As the number of total knee arthroplasty (TKA) procedures continues to rise in the context of bundled payment models, patients dissatisfied postoperatively that require additional care will impose additional cost to the healthcare system. The purpose of this study is to internally validate a predictive model for postoperative patient satisfaction after TKA.
In total, 484 consecutive primary TKA patients between January 2014 and January 2016 were included. Patients were stratified into 4 risk tiers based on scores of a retrospectively applied, 11-component novel knee survey for postoperative satisfaction: low risk (>96.5), mild risk (75-96.4), moderate risk (60-74.9), and high risk (<60). Binary logistic and multivariate linear regression models were constructed to determine whether the survey was predictive of satisfaction. A receiver operator curve was constructed to determine a threshold score below which patients were likely to experience postoperative dissatisfaction.
The mean (±standard deviation) age was 66.3 ± 9.2 years (range 31.7-100.1) and mean body mass index was 34.2 ± 8.2 kg/m (range 16.2-68.4). A knee survey score of 96.5 conferred a 97.5% sensitivity and 95.7% negative predictive value for satisfaction. Patients with higher knee survey scores had greater odds (odds ratio 1.03, 95% confidence interval 1.01-1.06, P = .003) of postoperative satisfaction. Increasing risk tier was significantly associated with decreased satisfaction (low risk 95.7%, mild risk 93.8%, moderate risk 86.4%, and high risk 80.4%; P = .007). The knee survey was not significantly correlated with complications (r = -0.43, P = .32).
This novel knee survey conferred a 97.5% sensitivity and 95.7% negative predictive value in identifying at-risk patients for postoperative dissatisfaction after primary TKA.
在按项目付费模式下，全膝关节置换术（TKA）的数量持续增加，术后不满意需要额外治疗的患者将给医疗系统带来额外的成本。本研究的目的是对 TKA 术后患者满意度的预测模型进行内部验证。
共纳入 2014 年 1 月至 2016 年 1 月间的 484 例初次 TKA 连续患者。根据一项回顾性应用的、包含 11 个项目的新膝关节术后满意度调查的评分，将患者分为 4 个风险分层：低危（>96.5）、轻度危险（75-96.4）、中度危险（60-74.9）和高危（<60）。构建二元逻辑回归和多变量线性回归模型，以确定该调查是否对满意度具有预测性。构建受试者工作特征曲线，以确定患者术后可能不满意的评分阈值。
患者平均（±标准差）年龄为 66.3 ± 9.2 岁（范围 31.7-100.1），平均体重指数为 34.2 ± 8.2kg/m（范围 16.2-68.4）。膝关节调查评分达到 96.5 分，对满意度的敏感性为 97.5%，阴性预测值为 95.7%。膝关节调查评分较高的患者术后满意度的可能性更大（比值比 1.03，95%置信区间 1.01-1.06，P=0.003）。风险分层越高，满意度越低（低危 95.7%，轻度危险 93.8%，中度危险 86.4%，高危 80.4%；P=0.007）。膝关节调查与并发症无显著相关性（r=-0.43，P=0.32）。
本研究中的新型膝关节调查对初次 TKA 后术后不满意的高危患者具有 97.5%的敏感性和 95.7%的阴性预测值。
