Beck Edward C, Nwachukwu Benedict U, Lee Elaine K, Chapman Reagan, Stubbs Allston J, Gitelis Matthew, Rasio Jonathan, Nho Shane J
Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2020 Mar 20;8(3):2325967120908821. doi: 10.1177/2325967120908821. eCollection 2020 Mar.
Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS).
To determine whether increased distance from a patient's home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS.
Cohort study; Level of evidence, 3.
A retrospective cohort analysis was performed on patients undergoing surgery for FAIS by a single surgeon from January 2012 through January 2017. A total of 692 patients were identified and split into 2 groups: driving distance of <50 miles from our institution (referral group) and driving distance of <50 miles from our institution (local group). Preoperative and 2-year postoperative scores on patient-reported outcome measures (PROMs), including the Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, International Hip Outcome Tool-12, and modified Harris Hip Score, were assessed. Patients achieving the MCID on any included PROM were analyzed using a chi-square analysis. Logistic regression was performed to determine whether driving distance and other demographic variables of interest had an effect on achieving the MCID. Study data were analyzed using PatientIQ, a cloud-based research and analytics platform for health care.
There were 647 patients who completed 2-year follow-up and were included in the analysis. Of these patients, 116 (17.9%) were identified as being ≥50 miles from their orthopaedic provider, and 531 (82.1%) were identified as having a driving distance of <50 miles. A total of 100 patients (86.2%) in the referral group reached the MCID, and 476 patients (89.6%) in the local group reached the MCID. There was no statistically significant difference in reaching the MCID on any of the included PROMs between the 2 groups ( = .364). The same result held when controlling for a number of factors including age, body mass index, and adjusted gross income with logistic regression.
When controlling for a number of factors including age, body mass index, and adjusted gross income, distance to a high-volume hip arthroscopic surgery center did not have an effect on postoperative outcome scores or achieving the MCID 2 years after undergoing surgery for FAIS.
既往研究评估了距离大型医疗中心的远近对关节置换术后结局的影响。然而，关于该距离对股骨髋臼撞击综合征（FAIS）行髋关节镜手术后的结局是否有影响，证据有限。
确定患者住所到其主要骨科诊所的距离增加是否会影响FAIS手术后在结局指标上达到最小临床重要差异（MCID）的能力。
队列研究；证据等级，3级。
对2012年1月至2017年1月由同一位外科医生为FAIS患者进行手术的病例进行回顾性队列分析。共纳入692例患者并分为两组：距离本院行车距离<50英里（转诊组）和距离本院行车距离<50英里（本地组）。评估患者报告结局量表（PROMs）的术前及术后2年评分，包括髋关节结局量表日常生活活动和特定运动亚量表、国际髋关节结局工具-12以及改良Harris髋关节评分。对在任何纳入的PROM上达到MCID的患者进行卡方分析。进行逻辑回归以确定行车距离及其他相关人口统计学变量是否对达到MCID有影响。研究数据使用PatientIQ（一个基于云的医疗保健研究和分析平台）进行分析。
647例患者完成了2年随访并纳入分析。其中，116例（17.9%）被确定距离其骨科医疗服务提供者≥50英里，531例（82.1%）被确定行车距离<50英里。转诊组共有100例患者（86.2%）达到MCID，本地组有476例患者（89.6%）达到MCID。两组在任何纳入的PROM上达到MCID方面无统计学显著差异（P = 0.364）。在通过逻辑回归控制包括年龄、体重指数和调整后总收入等多个因素时，结果相同。
在控制包括年龄体重指数和调整后总收入等多个因素后，距离大型髋关节镜手术中心的远近对FAIS手术后2年的术后结局评分或达到MCID没有影响。
