Carpenter Charlotte V E, Wylde Vikki, Moore Andrew J, Sayers Adrian, Blom Ashley W, Whitehouse Michael R
Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
BMC Musculoskelet Disord. 2020 Feb 21;21(1):118. doi: 10.1186/s12891-020-3127-6.
Dislocation, periprosthetic fracture and infection are serious complications of total hip replacement (THR) and which negatively impact on patients' outcomes including satisfaction, quality of life, mental health and function. The accuracy with which patients report adverse events (AEs) after surgery varies. The impact of patient self-reporting of AEs on patient-reported outcome measures (PROMs) after THR is yet to be investigated. Our aim was to determine the effect of confirmed and perceived AEs on PROMs after primary THR.
A prospective single-centre cohort study of patients undergoing primary THR, with one-year follow-up, was performed. Participants completed forms pre-operatively and 3, 6, 9 and 12 months post-operatively, including Work Productivity and Activity Impairment (WPAI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5D-3 L (EQ5D), Self-Administered Patient Satisfaction (SAPS) and AE reporting questionnaires. Results were reported in three groups: No AE, reported but not confirmed AE and confirmed AE. A generalised linear model was used to compare among groups using robust standard errors (SE).
Forty-one AEs were reported in a cohort of 417 patients (234 females), with 30 AEs reported by 3 months. Eleven (27 reported) infections, two (six reported) periprosthetic fractures and two (eight reported) dislocations were confirmed. Those in the no AE group reported significantly better outcomes that the reported AE group as measured by WOMAC Co-Eff 14.27 (p = 0.01), EQ5D - 0.128 (p = 0.02) and SAPS - 9.926 (p = 0.036) and the combined reported and confirmed AE groups as measured by WOMAC Co-Eff 13.72 (p = 0.002), EQ5D - 0.129 (p = 0.036) and SAPS - 11.512 (p = 0.004). No significant differences were seen in WPAI among groups.
Patients who report AEs have worse outcomes than those who do not, regardless of whether the AEs can be confirmed by standard medical record review methods. The observed negative trends suggest that patient perception of AEs may influence patient outcome in a similar way to those with confirmed AEs.
脱位、假体周围骨折和感染是全髋关节置换术（THR）的严重并发症，会对患者的预后产生负面影响，包括满意度、生活质量、心理健康和功能。患者报告术后不良事件（AE）的准确性各不相同。THR术后患者自我报告AE对患者报告结局指标（PROM）的影响尚待研究。我们的目的是确定初次THR后确诊和感知到的AE对PROM的影响。
对接受初次THR的患者进行了一项前瞻性单中心队列研究，并进行了为期一年的随访。参与者在术前以及术后3、6、9和12个月完成表格，包括工作效率和活动障碍（WPAI）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、欧洲五维健康量表-3L（EQ5D）、患者自我管理满意度（SAPS）和AE报告问卷。结果分为三组报告：无AE、报告但未确诊AE和确诊AE。使用广义线性模型，采用稳健标准误（SE）对各组进行比较。
417例患者（234例女性）的队列中报告了41例AE，其中3个月时报告了30例AE。确诊11例（报告27例）感染、2例（报告6例）假体周围骨折和2例（报告8例）脱位。无AE组患者在WOMAC协同效应为14.27（p = 0.01）、EQ5D为 -0.128（p = 0.02）和SAPS为 -9.926（p = 0.036）时报告的结局明显优于报告AE组，在WOMAC协同效应为13.72（p = 0.002）、EQ5D为 -0.129（p = 0.036）和SAPS为 -11.512（p = 0.004）时报告的结局明显优于报告和确诊AE合并组。各组间WPAI无显著差异。
报告AE的患者比未报告的患者预后更差，无论AE是否能通过标准病历审查方法确诊。观察到的负面趋势表明，患者对AE的感知可能以与确诊AE患者类似的方式影响患者结局。
