Perraut Gregory, Aneizi Ali, Nadarajah Vidushan, Sajak Patrick Mj, Smuda Michael P, Jauregui Julio J, Zhan Min, Packer Jonathan D, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S837-S843. doi: 10.1016/j.jcot.2020.06.014. Epub 2020 Jun 11.
Many patients opt for elective orthopaedic procedures to regain physical function. However, little data exist about patient-reported early postoperative function.
To characterize physical function two weeks postoperative from upper and lower extremity orthopaedic surgery and to determine pre-operative factors that are associated with physical function two weeks following surgery.
Patients 17 years and older undergoing elective orthopaedic surgery at one institution were enrolled prospectively and completed questionnaires prior to surgery and again two weeks postoperatively. The questionnaires included: six of the PROMIS computer adaptive questionnaires: Physical Function (PF), Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression; a joint-specific function questionnaire, a joint numeric pain scale, and a body numeric pain scale. Physical activity levels were measured using Tegner, IPAQ, and Marx. Responses were analyzed using Spearman's correlation coefficient, ANOVA, and multivariate linear stepwise regression with two-week PF as the dependent variable.
435 patients (47% female) with mean age 41.1 ± 15.7 were included in our final analysis. Mean baseline PF score was 42.1 and mean two-week PF score was 35.5 (p < .0001). Patients undergoing upper extremity surgery had higher PF at two weeks than those undergoing lower extremity surgery (39.1 vs 32.2, p < .0001). Younger age, Hispanic ethnicity, preoperative narcotic use, injury prior to surgery, and procedure all had a significant relationship with lower 2-week postoperative PF score (p < 0.05). Numerous baseline and 2-week measures were correlated with postoperative PF score, with 2-week Social Satisfaction demonstrating the strongest correlation (r = 0.604, p < .0001). Multivariable regression confirmed that the better preoperative PF score and upper extremity surgery were independent preoperative predictors of better 2-week PF scores.
Patients have a significant decline in physical function following orthopaedic surgery, with those undergoing lower extremity surgery having a significantly greater decline. Many factors are associated with activity levels, including mental health, pain, and satisfaction. This information can be used to help manage patients' short-term expectations.
许多患者选择择期骨科手术以恢复身体功能。然而，关于患者报告的术后早期功能的数据很少。
描述上下肢骨科手术后两周的身体功能特征，并确定与术后两周身体功能相关的术前因素。
前瞻性纳入在一家机构接受择期骨科手术的17岁及以上患者，并在手术前和术后两周再次完成问卷调查。问卷包括：六项PROMIS计算机自适应问卷：身体功能（PF）、疼痛干扰、疲劳、社会满意度、焦虑和抑郁；一份关节特定功能问卷、一份关节数字疼痛量表和一份身体数字疼痛量表。使用泰格纳、国际体力活动问卷（IPAQ）和马克思量表测量身体活动水平。以术后两周的PF为因变量，使用斯皮尔曼相关系数、方差分析和多元线性逐步回归分析回答结果。
435例患者（47%为女性）纳入最终分析，平均年龄41.1±15.7岁。平均基线PF评分为42.1，术后两周平均PF评分为35.5（p<.0001）。接受上肢手术的患者术后两周的PF高于接受下肢手术的患者（39.1对32.2，p<.ooo1）。年龄较小、西班牙裔、术前使用麻醉剂、手术前受伤和手术类型均与术后两周较低的PF评分有显著关系（p<0.05）。许多基线和术后两周的测量指标与术后PF评分相关，术后两周的社会满意度相关性最强（r=0.604，p<.0001）。多变量回归证实，术前较好的PF评分和上肢手术是术后两周较好PF评分的独立术前预测因素。
骨科手术后患者的身体功能显著下降，接受下肢手术的患者下降幅度更大。许多因素与活动水平相关，包括心理健康、疼痛和满意度。这些信息可用于帮助管理患者的短期期望。
