Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
Nicola Hewlett-Smith Allied Health Department, The Wesley Hospital, PO Box 499, Brisbane, 4066, Australia.
J Orthop Surg Res. 2020 Aug 27;15(1):360. doi: 10.1186/s13018-020-01854-9.
The introduction of enhanced recovery pathways has demonstrated both patient and organisational benefits. However, enhanced recovery pathways implemented for total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary between health-care organisations, as do their measures of success, particularly patient-related outcomes. Despite inpatient functional recovery being essential for safe and timely hospital discharge, there is currently no gold standard method for its assessment, and the research undertaken to establish prognostic factors is limited. This study aimed to identify prognostic factors and subsequently develop prognostic models for inpatient functional recovery following primary, unilateral THA and TKA; identify factors associated with acute length of stay; and assess the relationships between inpatient function and longer-term functional outcomes.
Correlation and multiple regression analyses were used to determine prognostic factors for functional recovery (assessed using the modified Iowa Level of Assistance Scale on day 2 post-operatively) in a prospective cohort study of 354 patients following primary, unilateral THA or TKA.
For the overall cohort and TKA group, significant prognostic factors included age, sex, pre-operative general health, pre-operative function, and use of general anaesthesia, local infiltration analgesia, and patient-controlled analgesia. In addition, arthroplasty site was a prognostic factor for the overall cohort, and surgery duration was prognostic for the TKA group. For the THA group, significant prognostic factors included pre-operative function, Risk Assessment and Prediction Tool score, and surgical approach. Several factors were associated with acute hospital length of stay. Inpatient function was positively correlated with functional outcomes assessed at 6 months post-operatively.
Prognostic models may facilitate the prediction of inpatient flow thus optimising organisational efficiency. Surgical prognostic factors warrant consideration as potential key elements in enhanced recovery pathways, associated with early post-operative functional recovery. Standardised measures of inpatient function serve to evaluate patient-centred outcomes and facilitate the benchmarking and improvement of enhanced recovery pathways.
引入强化康复路径已证明对患者和组织都有好处。然而，全髋关节置换术（THA）和全膝关节置换术（TKA）的强化康复路径在医疗机构之间存在差异，其成功衡量标准也是如此，尤其是与患者相关的结果。尽管住院期间的功能恢复对于安全和及时出院至关重要，但目前还没有评估其的金标准方法，用于确定预后因素的研究也很有限。本研究旨在确定预后因素，并随后为初次单侧 THA 和 TKA 后住院期间的功能恢复建立预后模型；确定与急性住院时间相关的因素；并评估住院期间功能与长期功能结果之间的关系。
采用相关性和多元回归分析，对 354 例初次单侧 THA 或 TKA 患者的前瞻性队列研究，确定功能恢复（术后第 2 天使用改良爱荷华辅助水平量表评估）的预后因素。
对于整个队列和 TKA 组，年龄、性别、术前一般健康状况、术前功能以及全身麻醉、局部浸润镇痛和患者自控镇痛的使用是显著的预后因素。此外，关节置换部位是整个队列的预后因素，手术时间是 TKA 组的预后因素。对于 THA 组，显著的预后因素包括术前功能、风险评估和预测工具评分以及手术入路。几个因素与急性住院时间长度有关。住院期间的功能与术后 6 个月的功能结果呈正相关。
预后模型可以帮助预测住院流程，从而优化组织效率。手术预后因素值得考虑作为强化康复途径的潜在关键要素，与术后早期功能恢复相关。住院期间功能的标准化衡量标准可用于评估以患者为中心的结果，并促进强化康复途径的基准测试和改进。
